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Oral surgery > Examination, diagnosis and treatment of periodontal diseases > Flashcards

Examination, diagnosis and treatment of periodontal diseases Flashcards

1
Q

Periodontitis defintion

A
  • Inflammatory process in periodontal space
  • Affects alveolar bone, soft tissues and lymphatics
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2
Q

Two main parts of periodontium

A
  • Periodontium periapicale(around root tip)
  • Periodontium marginale(Around alveolar ridge)
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3
Q

Periodontitis can be classified according to:

A
  • Aetiology
  • Type of inflammation
  • Location
  • Clinical course
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4
Q

Periodontitis classifications according to aetiology

A
  • Infectious
  • Trauma
  • Chronic
  • Chemotaxic
  • Allergic
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5
Q

Infectious organisms of Periodontitis

A
  • Micro-organisms from infected root canals or periodontal pockets
  • Aerobes
  • Anaerobes
  • Lactobacillus
  • Fusobacterium
  • Staphylococci
  • Streptococci
  • Actinomyces
  • Clostridium
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6
Q

Causes of infectious periodontitis

A
  • Untreated pulpitis
  • Improper treatment
  • Failure of root canal
  • Gangrenous roots
  • Periodontal defects
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7
Q

Types of trauma that cause periodontitis

A
  • Acute
  • Chronic
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8
Q

Acute trauma in periodontitis

A
  • Fracture of crown->
  • Disruption of vascular bundle
  • Influx of MO
  • Necrosis of pulp
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9
Q

Chronic trauma in periodontitis

A
  • Poorly designed restorations overload periodontium
  • Crowns
  • Bridges
  • Parafunction
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10
Q

Allergic causes of periodontitis

A
  • Allergy to dental materials
  • Hyperergic antigen antibody reactions
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10
Q

Chemotoxic causes of periodontitis

A
  • Irritating toxic drugs
  • Arsenic
  • Phenolic derivatives
  • Improper use of composite materials
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11
Q

Periodontitis classification according to location

A
  • Periapical
  • Total
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12
Q

Periodontitis classification according to type of inflammation

A
  1. Exudative
    * Serous
    * Purulent
  2. Proliferative
    * Granulomatous
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13
Q

Periodontitis classification according to Clinical course

A
  • Sharp
  • Chronic
  • Excacerbated
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13
Q

Acute periodontitis classifications

A
  • Periodontitis periapicalis acuta- serosa et purulenta
  • Periodontitis marginalis acuta- Serosa et purulenta
  • Periodontitis totalis acuta
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14
Q

Chronis periodontitis classifications

A
  • Periodontitis periapicalis chronica granulomatosa diffuse(sin/cum fistulae)
  • Periodontitis periapicalis chronica granulomatosa localisata
  • Periodontitis periapicalis chronica fibrosa
  • Periodontitis chronica exacerba
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15
Q

The clinical course of periodontitis depends on:

A
  • Aetiology
  • Location and type of process
  • Microbial contamination
  • Virulence of microorganisms
  • Local and general immune status
  • Age
  • Contomitant diseases
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16
Q

Important anamnestic data for diagnosis of periodontitis

A
  • Presence of pain
  • Socrates
  • Site
  • Onset
  • Character
  • Radiation
  • Associated symtoms
  • Time
  • Exacerbating factors
  • Severity
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16
Q

Important criteria assessed during periodontitis examination

A
  • Adjacent teeth
  • Mucous membranes
  • Percussion of tooth-horiontal/vertical
  • Pressure on tooth(V/H)
  • Palpation(root tip/marginal gingiva)
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17
Q

Acute periapical periodontitis definition

A

Acute inflammation of periapical periodontium and adjacent bone

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17
Q

Acute serous periodontitis characteristics

A

Inflammation of pulp causing:
* Hyperemia
* Extravasation of cellular elements and exudate
* Edema
* Bone resorption
* Serous exudate->purulent

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18
Q

Acute serous periodontitis clinical presentation

A
  • Pain similar to pulpitis
  • Pain on percussion
  • May or may not be able to localise
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19
Q

Treatment of Acute serous periodontitis

A
  • Endodontic treatment
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20
Q

Phases of Acute Purulent periodontitis

A
  • Periodontal
  • Endosteal
  • Subperiosteal
  • Submucosal
21
Periodontal phase of Acute Purulent periodontitis characteristics
* Serous exudate-> Purulent * Mixed virulent microflora * Complement activation * Infiltration of neutrophils and macrophages * Spreading bone resorption * Strong constant pain intensifying on percussion
22
Periodontal phase of Acute Purulent periodontitis general symptoms
* Slightly enlarged and painful lymph nodes * General malaise
22
Periodontal phase of Acute Purulent periodontitis paraclinical tests
* No radiological changes * Tooth doesnt react to pulp testing
23
Differential diagnosis of Periodontal phase of Acute Purulent periodontitis
* Purulent pulpitis * Pulp-periodontitis * Localised ostemyelitis
24
Treatment of Periodontal phase of Acute Purulent periodontitis
* Endodontic treatment * Extraction * Antibiotics
25
Endosteal phase of Acute Purulent periodontitis characteristics
* Process continues expansion into bone * Constant throbbing pain * Unbearable pain on percussion * Regional lymph nodes enlarged and pain
26
Endosteal phase of Acute Purulent periodontitis general condition
* Malaise * Tremor * Low grade fever * Rapid heart beat * Headache * Insomnia ## Footnote Most are minor symtoms
27
Treatment of Endosteal phase of Acute Purulent periodontitis
* Endodontic treatment * Extraction * Medication ## Footnote Medication: Anti-inflammatory, antibiotic(Clindamycin), analgesic, Antipyretic
28
Periosteal/subperiosteal phase of Acute Purulent periodontitis characteristics
* Increased invasion of bone * Increase in purulence * Spontaneous very strong pain, mucosa hyperemic and edematous * Mobility ## Footnote MOST PAINFUL STAGE
29
Periosteal/subperiosteal phase of Acute Purulent periodontitis general condition
* Regional lymph nodes enlarged
30
Periosteal/subperiosteal phase of Acute Purulent periodontitis paraclinical tests
* X-ray same as endosteal phase
31
Periosteal/subperiosteal phase of Acute Purulent periodontitis treatment
* Draining of abcess * Endo * Medication- Analgin, Ibuprofen(400mg), Amoxicillin(1000mg x2), metranidazole
32
Periosteal/subperiosteal phase of Acute Purulent periodontitis differential diagnosis
* Different phases of periodontitis * Osteomyelitis * Exacerbated cysts
33
Submucosal abcess Acute Purulent periodontitis characteristics
* Purulent collection below periosteum forms abcess * Decrease in pain * Hyperemia and severe edema-spread => Abcesses and phlegmons ## Footnote Edema spreads to: lips, cheeks, nasolabial folds, eyelids, sublingual, submental and submandibular space
34
Submucosal abcess Acute Purulent periodontitis general condition
* Tremor * fatigue * Loss of apetite * Headache * High temperature * Increased HR
35
Submucosal abcess Acute Purulent periodontitis paraclinical studies
* Radiographic changes difficult to detect * Leukocytosis * Accelerated ESR * C- reactive protein
36
Characteristics of Chronic periodontitis
* Can occur w/ low virulence mo and good immune status * Long course-months/years * Proliferation->Blood vessels+tissues * Fibrosis of connective tissue
37
Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) characteristics | Chronic granulating periapical periodontitis
* Chronic purulent proliferative process in bone * Bone resorption * No subjective complaints/pain * Tooth may be darker in colour * Tooth apex that leaks * Fistula that may be located away from causative tooth * Acute exacerbations may occur- painful, edema and hyperaemia
37
Diagnosis of Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) | Chronic granulating periapical periodontitis
* Periodic exacerbations * Presence of fistula * Blurred outline of bone on x-ray
37
Treatment of Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) | Chronic granulating periapical periodontitis
* Endo * Tooth extraction * Resection of root tip * Hemisection * Anti-inflammatory treatment-osteotrophic drugs
38
Periodontitis periapicalis chronica granulomatosa (sin/cum fistula) differential diagnosis Chronic granulating periapical periodontitis
* Chronic osteomyelitis * Other chronic periodontitis
39
Periodontitis periapicalis chronica granulomatosa localisata characteristics ## Footnote Chronic periapical granulomatous localisaed periodontitis
* Necrosis and bone destruction replaced by granulation tissue * Granulation tissue formation followed by fibrosis w/ proper treatment and optimal response * Granulation tissue becomes granuloma with inadequate treatment or poor response
40
Granulation tissue cells
* Well vascularised and rich in cells * Fibroblasts * Endothelial cells * Plasma cells * Mast cells
41
Granuloma characteristics
* Chronic inflammatory response- Granulation tissue rich in cells and blood vessels * Connective tissue capsule-> limits penetration of infection
42
Types of Granuloma according to their histology
* Common Granuloma/granuloma simplex * Epithelialising granuloma * Cystic granuloma/Granuloma cycsticum
43
Diagnosis of granuloma
* Ask about past pain * Exacerbations? * Mild pain on percussion * Round shadow around root radiographically
44
Differential diagnosis of Granuloma
* Diffuse granulating and fibrous periodontitis * Localised osteomyelitis * Radicular cyst
45
Treatment of granuloma
* Extraction * Endo * Surgical removal of granuloma * Hemisection of roots * Less common-reimplantation and autotransplantation of root
46
Periodontitis periapicalis chronica fibrosa characteristics
Following endo treatment * Granulation tissue replaced w/ fibrous tissue * Reduction in cells- w/exception of fibroblasts * Reduction in blood vessels * Fibrous tissue replaced w/ bone after some months ## Footnote Healing phase of acute and chronic periodontitis
47
Treatment of chronic periodontitis
* Extraction-Followed by removal /currettage of pathologically altered tissue/granuloma * Endo-rare * Surgical methods
48
Surgical methods of treatment of Chronic Periodontitis
* Apical osteotomy * Hemisection * Amputation * Reimplantation * Autotransplantation * Coronory radicular seperation
49
Apical osteotomy/resection of root tip/Resectio apics dentis Indications
* Chronic periapical periodontitis * Radicular cysts * Curved/impossible to access canals w/ pain, discomfort and inflammation * Perforation of root near apex * Failed endo * Root fractures(distal)
50
Apical osteotomy/resection of root tip/Resectio apics dentis Contraindications
* More than 1/3 root involved and poor chance of healing * Advanced periodontal process
51
Apical osteotomy/resection of root tip/Resectio apics Procedure
* LA * Incision at apex * Flap * Bone perforated w/ round bur * Detection of apex and granulation tissue * Removal of GT * Obturation of root canals w/ non absorbable material * Retrograde filling of canals also can be done * Suturing

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