Final- Acute Periodontal Lesions and Mucogingival Conditions Flashcards
Acute periodontal lesions include:
- periodontal abscesses
- Necrotizing periodontal diseases
- Endo Perio lesions
____% of all emergency patients, 3rd most common
___% of untreated periodontal patients
____% of patients in active periodontal treatment
___% of patients in periodontal maintenance
7-14% of all emergency patients, 3rd most common
60% of untreated periodontal patients
13.5% of patients in active periodontal treatment
37% of patients in periodontal maintenance
What is the etiology of periodontal abscess?
- pulp necrosis
- periodontal infections
- periocoronitis
- trauma
- surgery
- foreign body impaction
Localized accumulation of puss located within the gingival wall of the periodontal pocket, with an expressed periodontal breakdown occurring during a limited period of time, and with easily detectable clinical symptoms:
periodontal abscess
List the sequence of events leading to periodontal abscess formation:
- occlusion of existing periodontal pocket
- bacterial invasion of soft tissue wall
- leukocytic infiltration (neutrophils)
- vascular thrombosis
- edema and swelling
- tissue necrosis & liquefaction
- collagenolysis & bone resorption
- production of purulent exudate
OBLV-ETCP
List the most common symptoms of acute periodontal disease in order of most common to least common:
- Pain
- Swelling & edema
- Lymphadenopathy
- Fever
______ formation is often a manifestation of:
- diabetes (uncontrolled or undiagnosed): most common cause
- AIDS (compromised immune system)
- Depressed immune system (steroid therapy, chemotherapy)
Multiple abscess
MULTIPLE ABSCESS FORMATION is foten a manifestation of: (3)
- Diabetes
- AIDS
- Depressed immune system
What is the most common cause of multiple abscess formation?
uncontrolled or undiagnosed diabetes
65% of the microbial flora is ____ & ___ (that cause periodontal abscesses)
gram-negative; anaerobic
Bacteria that produce _____, such as P. gingivalis and P. intermedia are important in the pathogenesis of the periodontal abscess since they increase the availability nutrients, and thereby increase the number of bacteria within the abscess environment
proteinases
Bacteria that produce PROTEINASES, such as _____ and ____ are important in the pathogenesis of periodontal abscess
P. gingivalis; P. intermedia
Bacteria that produce proteinases such as P. gingivalis and P. intermedia are important in the pathogenesis of the periodontal abscess since they increase _____, and thereby increase the _____ within the abscess environment
the availability of nutrients; number of bacteria
List the common pathogens found in a periodontal abscess: (7)
- Candida albicans
- Fusobacteria nucleatum
- Peptostreptococcus micros
- Porphyromonas gingivalis
- Prevotella intermedia
- Tanerella forsythia
- Treponema (spirochetes)
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List the characteristic histopathology of a periodontal abscess: (5)
- acute inflammatory infiltrate
- vascular hyperemia & thrombosis
- lysis of collagen matrix in the lamina propria and the gingival fibers
- ulceration and apical proliferation of JE
- osteoclastic mediated bone resorption
A periodontal abscess in a periodontitis patient could represent a period of:
disease exacerbation
A periodontal abscess in a periodontitis patient could represent a period of disease exacerbation due to the presence of: (5)
- tortuous pocket
- furcation involvement
- vertical defect
- composition of microflora
- decreased host defense
When is a periodontal abscess in a periodontitis patient due to an acute exacerbation?
- in untreated periodontitis
- in patients non-responsive to periodontal therapy
- in patients on supportive periodontal therapy
A periodontal abscess in a periodontitis patient can form after _____ and so their need for ____.
treatment (post-scaling & post-surgery); Post-medication (antimicrobial and Nifedipine)
A periodontal abscess in non-periodontitis patients may result from: (5)
- impaction of foreign bodies
- harmful habits
- orthodontic factors
- gingival enlargement
- alteration of root surface
List some examples of alteration in root surfaces that can lead to a periodontal abscess in non-periodontitis patients?
- Dens invaginitis
- Cemental tears
- Enamel pearls
- Perforations (Iatrogenic)
- Severe root damage (VRF or cracked tooth syndrome)
- External root resorption
What are the clinical signs of periodontal abscess: (10)
- Pain
- Localized swelling and fluctuence
- Purulent exudate
- Deep periodontal pocket
- Vital pulp
- Fistula
- Tooth mobility
- Sensitivity to percussion
- Low grade fever
- Lymphadenopathy
The following are all _____ of _____
- Pain
- Localized swelling and fluctuence
- Purulent exudate
- Deep periodontal pocket
- Vital pulp
- Fistula
- Tooth mobility
- Sensitivity to percussion
- Low grade fever
- Lymphadenopathy
Clinical signs of periodontal abscess
List some differential diagnoses for periodontal abscesses: (6)
- PA abscess
- Acute pulpitis
- Tooth or root fracture
- Pericoronitis
- Lateral periodontal cyst
- Gingival cyst
- PA abscess
- Acute pulpitis
- Tooth or root fracture
- Pericoronitis
- Lateral periodontal cyst
- Gingival cyst
These are all:
differential diagnoses for periodontal abscesses
List complications of periodontal abscesses: (3)
- Tooth loss (up to 45% of teeth with perio abscesses in maintenance are extracted)
- Bacteremia (following abscess treatment)
- Chronic or episodic bacteremia from untreated periodontal disease
One complication of perio abscess is tooth loss. Provide the statistic:
Up to 45% of teeth with periodontal abscesses in maintenance are extracted
T/F: A complication of perio abscess is bacteremia. This can be chronic or episodic from untreated perio disease OR following abscess formation
Both statements true
List the potential treatment options for perio abscess: (5)
- non-surgical drainage & debridement with LA
- surgical drainage for large abscess
- surgical therapy with flap reflection, debridement with ultrasonic, sutures
- antibiotics if systemic infection is indicated by fever or lymphadenopathy
- re-evaluation and any further needed therapy
Non-surgical drainage for treating a perio abscess is typically done with:
local anesthetic
When would surgical drainage be indicated for a perio abscess?
large abscess
Describe surgical therapy for a perio abscess:
- surgical therapy with flap reflection
- debridement with ultrasonic
- sutures
When would antibiotics be indicated for perio abscess treatment?
If systemic infection is indicated by fever or lymphadenopathy
What are the components of diagnosis when dealing with a perio abscess?
- Health history + medications
- Dental history
- Current perio status
- Current status of affected tooth
- PA radiographs
- Clinical exam
- Determine etiology
When taking a health history and medications for a patient with a perio abscess you should note:
- diabetic status
- systemic antibiotic use
When diagnosing a perio abscess, how can the current status of the affected tooth be determined?
- Cold and EPT tests vital
- Pain on percussion
What type of radiographs should be taken for a potential perio abscess?
PA radiographs
What should be noted on the clinical examination when diagnosing a perio abscess?
- redness
- swelling
- purulent discharge
- lymphadenopathy