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periodontology 2 > management of periodontal emergencyes > Flashcards

management of periodontal emergencyes Flashcards

1
Q

what % of general population suffer orofacial pain in preceding 6 months?

A

22%

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2
Q

What is a periodontal abscess?

A

area of periodontal breakdown with pus.

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3
Q

Whats the prevelance of periodontal abscess?

A

3rd most dental emergency

7-14% of all dental emergencies

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4
Q

how are abscesses classified?

A

gingival

periodontal

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5
Q

what areas do gingival abscesses effect?

A

marginal and interdental gingiva

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6
Q

whats the main cause of gingival abscess?

A

impacted foreign objects

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7
Q

periodontal abscess effect what areas?

A

same as gingival but pockets are deeper, includes furcations, and vertical osseus defects
usually located beyond the mucogingival line

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8
Q

what can you expect on Radiographic evaluation of absscesses

A

look for bone loss around the crest which may extend into apical region
calculus, foreign material

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9
Q

describe an acute abscess

A 
mild to severe discomfort
localized red, ovoid swelling
mobility
tooth elevation in socket
tenderness
exudation
elevated temperature
regional lymphadenopathy
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10
Q

describe an chronic abscess

A 
no pain, or dull pain
localized inflammatory lesion
slight tooth elevation
intermittent exudation
fisulous tract often associated with dep pocket
usually without systemic involvement
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11
Q

how to treat periodontal abscesses

A

drain, SRP, periodontal surgery, systemic antibiotics, tooth removal

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12
Q

when should you be worried about endodontic problems?

A

if the abscess extends into apical region which may cause pulpal necrosis
requires pulp testing

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13
Q

under what conditions does periodontal abscesses require immediate treatment?

A

cellulitis
fever
regional lymphadenopathy
immunocompromised people

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14
Q

what causes primary herpetic gingivostomatitis?

A

herpes simplex virus 1

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15
Q

how is primary herpetic gingivostomatitis aquired?

A

contact with infected lesion or body fluids

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16
Q

what are signs and symptoms of herpetic gingivostomatitis?

A 
prodomal state ( fever & malaise)
pain
cervical adenitis
fever ( 103-104)
dehydration
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17
Q

oral manifestation of primary herpetic gingivostomatitis

A

diffuse erythematous lesions on gingiva and oral mucosa including lips, cheeks, pharynx and palate
vesicles rupture leaving lesions with red elevated halo like marginswith necrotic center

18
Q

how is primary herpetic gingivostmatitis treated?

A

viscous lidocaine to help soothe lesions

they also need to rehydrate so give them gatorade or somthign

19
Q

what 2 medications can you give someone with primary herpetic gingivostomatitis?

A

acyclovir- initial episode or intermittent therapy ( 200mg orally every 4 hours up to 5 times a day for 10 days)
valacyclovir- 2 grams twice a day for 1 day.

20
Q

Define pericoronitis

A

inflammation of oral soft tissues surrounding the crown of a partially erupted tooth
radiates pain to ear, throat, and floor of mouth

21
Q

treatment of pericoronitis depends onwhat 3 things

A

severity of inflammation
systemic complications
advisability of retaining the involved tooth

22
Q

immediate treatment of pericoronitis involves what?

A

systemic antibiotics

incision may be necessary to drain and relieve pressure

23
Q

definitive treatment of pericoronitis involves……

A

surgical incision called operculectomy

extraction of either offendingor opposing tooth

24
Q

whats the antibiotic of choice to treate pericoronitis?

A

amoxicillin of amoxicillin with clavulanic acid

25
Q

when would you want to do a operculectomy?

A

Offending molar is ooccluding on it
if its close to anatomic structures like maxillary sinus or IAN
prosthetic consideration

26
Q

whats ludwigs angina?

A

fascial infection with bilateral involvement of submandibular, sublingual, and submental spaces

27
Q

what bacteria causes ludwigs angina?

A

streptococcus and staphylococcus

28
Q

if mixed aerobic/anaerobic infection is present in someone with ludwigs angina, what bacteria is causing it?

A

B. Fragilis

29
Q

Ludwigs angina may close the airway so its important to open it back up. What could you do to open up someones airway?

A

fiberoptically
cricothyrotomy
traceostomy

30
Q

What are some antibiotics used for ludwigs angina?

A 
Ampicillin/Sulbactam (Unasyn)
Ticarcillin/Clauvulate (Timentin)
Piperacillin/Tazobactam (Zosyn)
Clindamycin + Cipro (PCN allergy) 
Flagyl (B. Fragilis)
31
Q

Necrotizing ulcerative gingivitis NUG commonly results in……

A

interproximal necrosis and ulceration
history of soreness and bleeding
pseudomembrane

32
Q

T/F, NUG effects all of the teeth.

A

F, the degree of involvment varies considerably from site to site

33
Q

how to diagnose NUG

A 
all off clinical findings
"my entire freaking mouth hurts"
pain more intense around ulcerations
spontaneous bleeding
spicy foods, hor or cold drinks may be intolerable
34
Q

whats the goal of the initial therapy for NUG?

A

to reduce the microbial load and remove necrotic tissue to a degree regeneration can occur

35
Q

should you SRP during initial visit for NUG?

A

no way!

36
Q

how long does the NUG Pt need to be symptom free before procedures like extractions or perio surgery can occur?

A

4 weeks

37
Q

what antibiotics can be used for NUG?

A

Systemic antibiotics- Amoxicillin 500mg QID / Erythromycin 500mg QID / Metronidazole 500mg BID

38
Q

NUG 2nd visit key points

A 
1-2 days after initial visit
re-evauluate
check pain
gingival margins should still be erythematous but without pseudomembrane
Now you can scale if sensativity permits
39
Q

NUG 3rd visit key points

A

5 days after 2nd visit
re-evaluate
establish comprehensive treatment which might need gingival recontouring

40
Q

If NUG keeps coming back with someone with immunosuppression what should you do?

A

refer to physician

41
Q

explain inadequate local therapy recurrence for NUG

A

when treatment is discontinued when the symptoms have subsided and it keeps coming back

periodontology 2 (8 decks)

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