lecture 7 acute periodontal lesions

Question 1

what is the 3rd most common reason for ER visits

Answer 1

periodontal abscess

Question 2

what needs to happen for a periodontal abscess to occur?

Answer 2

pocket needs to be occluded

Question 3

sequence of events leading to abscess formation (8)

Answer 3

1. occlusion of periodontal pocket
2. bacterial invasion of soft tissue wall.
3. Leukocytic infiltration (neutrophils)
4. Vascular thrombosis
5. edema and swelling
6. tissue necrosis and liquefaction
7. collagenolysis and bone resorption
8. production of purulent exudate

Question 4

most common symptoms of acute periodontal ds

Answer 4

1. PAIN
2. swelling and edema
3. lymphadenopathy
4. fever

in order of decreasing frequency

Question 5

when should you give pt anitbiotics?

Answer 5

if they have fever or swollen lymph nodes

Question 6

effect of abscesses on bone

Answer 6

abscesses are acute = fast
this means that it will cause rapid bone destruction

Question 7

if a pt has multiple abscess it is often a manifestation of

Answer 7

• diabetes
• AIDS
• depressed immune system (steroid therapy or chemotherapy)

Question 8

if a pt is on 1,000mg of metformin what does that mean?

Answer 8

DM medication, on average metformin is 500mg.

if on 1,000mg it shows that it is not really controlled DM

Question 9

microbio of periodontal abscess

Answer 9

65% are gram neg and anaerobic

and bacteria that produce proteinases (P. gingivalis, P. intermedia)

Question 10

histopath of abscess

Answer 10

**acute inflammatory infiltrate (LOTS of PMNs)

• vascular hyperemia and thrombosis
• lysis of the collagen matrix in the lamina propria and the gingival fibers
• ulceration and apical proliferation of JE
• osteoclastic mediated bone resorption

Question 11

after tx options for periodontitis pt with a periodontal abscess

Answer 11

• post-scaling
• post-surgery
• post medications (antimicrobials, nifedepine Ca channel blockers)

Question 12

if you tx a pt with an abscess in a nonsx way and pt came back with an abscess again, what happened?

Answer 12

during the sub g scaling or when removing the calculus, a little bit was left behind. Probably cannot be reached non-sx so have to do a sx approach this time.

Question 13

differential dx of periodontal abscess

Answer 13

1. periapical abscess
2. acute pulpitis
3. tooth or root fracture
4. periocoronitis
5. lateral peridontal cyst
6. gingival cyst

Question 14

tx option for periodontal abscess

Answer 14

1 is non sx driange and debridement with local anestheti

• surgical drainage for large abscess
• sx therapy with flap reflection, debridement with ultrasonic, sutures, SRP
• ab if systemic infection indicated by fever or lymphadenopathy only
• reeval and any further therapy

Question 15

if a pts has pain what 4 things can it be `

Answer 15

1. acute pericoronitis
2. acute periodontal abscess
3. acute herpetic gingivostomatitis
4. acute necrostizing ulcerative gingivits.

Question 16

how common is gingival recession

Answer 16

very common

54.5% of young adults

100% of middle aged-elderly adults with an average prevalence of 78.6%

Question 17

CEJ Class A vs Class B

Answer 17

A: CEJ detectable with/out step

B: CEJ undetectable with/out step

Question 18

cario classification for gingival recession RT1

Answer 18

100% root coverage can be predictated

Question 19

cario classification for gingival recession RT2

Answer 19

mixed results

Question 20

cario classification for gingival recession RT3

Answer 20

full root coverage is not achievable