OSPE Flashcards
What is a periodontal abscess?
It can be an acue infection that involves a localisd area of pus in the periodontium. Circumscribed - localised and confined to specific site.
z8 Rapid destruction of periodontal tissues: impacts prognosis. Can result in systemic infection.
What is the aetiology of PA?
Inflammatory process due to bacterial invasion (PMNS →cytokins - CT destruction). of soft tissues surrounding pocket.
What are 3 aetiological factors for patients with pre-existing periodontitis?
- Reduced ability to drain = ↑ suppuration due to change in subgingival microbiotia/↓ host defence
- Foreign object in surrounding structures
- Incomplete calc removal
What else could cause aetiology of pre-existing periodontitis?
Foreign object in supporting structures, harmful habits, ortho factors, gingival enlargement, altered root surface
What is a feature of abscess’ of the periodontium?
Symptoms:
Bad taste, difficulty chewing, pain
Signs: ↑ mobility, suppuration on probing, ↑ systemic involvement, odema is gingiva, BOP, can be deeper pockets
What is this? PIC
Periodontal abscess
On a radiograph how will PDA present?
Boneless in area of abscess but not involving tooth apex.
Tooth is usually vital.
How do you diagnose a PDA?
- History of cc
- Presence of perio pocket
- Vitality testing
- Location of abscess
- Caries
- Radiographic assessment
Differential diagnosis: PA, verticle root frac, perio-endo abscess, PO pain
What is the recommended treatment for PDA?
Establish aetiological factors and address.
LA
Establish path of drainage for pus via pocket, may require periodontal surgery - refer.
(REFER)
Debridement will drain this also.
Analgesics / antibiotic (only systemic)
Warm saline rinses
Review and or refer + full perio assessment
Define Necrotising Periodontal Diseases (NPD)
Acute infection of periodontal tissues that involve tissue necrosis. Appears to be related to diminished systemic resistance to bacterial infection.
What are the distinguishing characteristics of NPD (ANUG)
Tissue necrosis, ulceration, pseudomembrane, punched out papillae
What are risk factors for NDP?
Microbiology, host immune response and predisposing factors.
→→Stress, poor PH, age, alcohol+tobacco consumption, HIV/AIDS
What are the clinical features of NPD?
Sudden onset with intense pain. Punched out or cratered papillae, tissue necrosis. Pseudomembrane, erythametous, hallitosis.
Possible systemic involvement .
Mostly occurs in sextant 5 interproximally.
How do you manage first app NPD?
1st appointment:
- Subgingival debridement - under LA
- OHI - soft tbing
- Chlorhexadine/hydrogen peroxide 2x per day
- Smoking cessation
- Analgesics/antibiotics eg. Metronidazole
- Review 48-72
How do you manage 2nd app for NPD?
After 48-72: Further OHT Further instrumentation 3rd app: (5 days) - Reinforce OHI - Complete debridement if nec FU: review and full perio essessment
What is Necrotising Periodontitis?
Similar features of NPD, but affects periodontium (bone).
Necrosis progresses into PDL and alveolar bone → attachment loss. Extreme and rapid destruction.
(Systemic involvement - commonly reported in HIV pts).
How do you manage necrotising periodontitis?
Refer to periodontist.
Define periocoronitis
Inflammation and infection due to accumulation of debris and bacteria underneath the operculum. Most common in PE 8’s.
Whats the treatment for periocoronitis?
LA.
Periodontal instrumention and irrigation under operculum with chlorhexadine/sterile saline.
Analgesics, antibiotics if required.
Occlusal adjustment
Recommend warm saline/chlorhexidine rinses
Review + full perio assessment
Referral for exo
Define Primary Herpetic Gingivostomatitis
Caused y HSV, primary episode common in childhood.
Highly contagious, spread though kissing, contact with open sore, contact with infected saliva. Can spread from another part of body to another
What are symptoms of Primary herpetic gingivostomatits?
IO lesions, ulcers, lips, palate, tongue, gingivae tissues, difficulty eating and drinking, oedematous, erythematous gingiva.
May have fever
What is the management of PHG?
Oral fluids, anti-pyretic meds, analgesia, topical anaesthetic, refer to GF if unable to tolerate fluid.
Shold regress in 2 weeks
What is an endo-periodontal lesion?
Refers to concurrent endodontic and periodontic disease. Both of bacterial origins transferring to apical or surroinding tissues
What is the pathophysiology of an endo-periodontal lesion?
Communication pathways between pulp and periodontium.
- Apical foramen
- Accessory or lateral cancels
- Dentine tubules
What are causes of endo-periodontal lesions?
Trauma and iatrogenic factors such as:
root/pulp chamber/ furcation perforation
- Root frac or cracking
- External root resorption
How can you tell if it;s a endo-periodontal lesion?
Sensibility testing will come back negative
How do you manage a perio-endo lesion?
Refer to dentist -
Define peri-Implant disease
Refers to inflammation associated with dental implants.
Define osseointergration
Direct contact of bone to the surface of an implant body with no intervening CT.
What constitutes peri-implant health?
No erythema, no BOP, no swelling, no suppuration.
- Not defined by pocket depth reading.
Define peri-implant mucositis
Peri-implant mucosal inflammation in absence of continuous marginal peri-implant bone loss.
↑ Association with plaque accumulation.
What are features of peri-implant mucositis?
BOP, no loss of supporting bone.
Presence of:
Erythema, odema, suppuration, ↑ probing
PICWhat is this condition?
Peri-Implant mucositis
Define peri-implantitis
Inflammation associated with loss of supporting bone surrounding an implant.