management of periodontal emergencyes Flashcards
what % of general population suffer orofacial pain in preceding 6 months?
22%
What is a periodontal abscess?
area of periodontal breakdown with pus.
Whats the prevelance of periodontal abscess?
3rd most dental emergency
7-14% of all dental emergencies
how are abscesses classified?
gingival
periodontal
what areas do gingival abscesses effect?
marginal and interdental gingiva
whats the main cause of gingival abscess?
impacted foreign objects
periodontal abscess effect what areas?
same as gingival but pockets are deeper, includes furcations, and vertical osseus defects
usually located beyond the mucogingival line
what can you expect on Radiographic evaluation of absscesses
look for bone loss around the crest which may extend into apical region
calculus, foreign material
describe an acute abscess
mild to severe discomfort localized red, ovoid swelling mobility tooth elevation in socket tenderness exudation elevated temperature regional lymphadenopathy
describe an chronic abscess
no pain, or dull pain localized inflammatory lesion slight tooth elevation intermittent exudation fisulous tract often associated with dep pocket usually without systemic involvement
how to treat periodontal abscesses
drain, SRP, periodontal surgery, systemic antibiotics, tooth removal
when should you be worried about endodontic problems?
if the abscess extends into apical region which may cause pulpal necrosis
requires pulp testing
under what conditions does periodontal abscesses require immediate treatment?
cellulitis
fever
regional lymphadenopathy
immunocompromised people
what causes primary herpetic gingivostomatitis?
herpes simplex virus 1
how is primary herpetic gingivostomatitis aquired?
contact with infected lesion or body fluids
what are signs and symptoms of herpetic gingivostomatitis?
prodomal state ( fever & malaise) pain cervical adenitis fever ( 103-104) dehydration
oral manifestation of primary herpetic gingivostomatitis
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
how is primary herpetic gingivostmatitis treated?
viscous lidocaine to help soothe lesions
they also need to rehydrate so give them gatorade or somthign
what 2 medications can you give someone with primary herpetic gingivostomatitis?
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.
Define pericoronitis
inflammation of oral soft tissues surrounding the crown of a partially erupted tooth
radiates pain to ear, throat, and floor of mouth
treatment of pericoronitis depends onwhat 3 things
severity of inflammation
systemic complications
advisability of retaining the involved tooth
immediate treatment of pericoronitis involves what?
systemic antibiotics
incision may be necessary to drain and relieve pressure
definitive treatment of pericoronitis involves……
surgical incision called operculectomy
extraction of either offendingor opposing tooth
whats the antibiotic of choice to treate pericoronitis?
amoxicillin of amoxicillin with clavulanic acid
when would you want to do a operculectomy?
Offending molar is ooccluding on it
if its close to anatomic structures like maxillary sinus or IAN
prosthetic consideration
whats ludwigs angina?
fascial infection with bilateral involvement of submandibular, sublingual, and submental spaces
what bacteria causes ludwigs angina?
streptococcus and staphylococcus
if mixed aerobic/anaerobic infection is present in someone with ludwigs angina, what bacteria is causing it?
B. Fragilis
Ludwigs angina may close the airway so its important to open it back up. What could you do to open up someones airway?
fiberoptically
cricothyrotomy
traceostomy
What are some antibiotics used for ludwigs angina?
Ampicillin/Sulbactam (Unasyn) Ticarcillin/Clauvulate (Timentin) Piperacillin/Tazobactam (Zosyn) Clindamycin + Cipro (PCN allergy) Flagyl (B. Fragilis)
Necrotizing ulcerative gingivitis NUG commonly results in……
interproximal necrosis and ulceration
history of soreness and bleeding
pseudomembrane
T/F, NUG effects all of the teeth.
F, the degree of involvment varies considerably from site to site
how to diagnose NUG
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
whats the goal of the initial therapy for NUG?
to reduce the microbial load and remove necrotic tissue to a degree regeneration can occur
should you SRP during initial visit for NUG?
no way!
how long does the NUG Pt need to be symptom free before procedures like extractions or perio surgery can occur?
4 weeks
what antibiotics can be used for NUG?
Systemic antibiotics- Amoxicillin 500mg QID / Erythromycin 500mg QID / Metronidazole 500mg BID
NUG 2nd visit key points
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
NUG 3rd visit key points
5 days after 2nd visit
re-evaluate
establish comprehensive treatment which might need gingival recontouring
If NUG keeps coming back with someone with immunosuppression what should you do?
refer to physician
explain inadequate local therapy recurrence for NUG
when treatment is discontinued when the symptoms have subsided and it keeps coming back
