Other Periodontal Conditions Flashcards
What are the different mucogingival deformities and conditions?
- gingival phenotype: Thin gingiva covering bone/ teeth
- Decrease vestibular depth: atrophy
- Aberrant frenum/muscle position: Frenum pull
- Gingival excess
- Condition of the exposed root surface (Fenestration, dehiscence)
- gingival soft tissue recession
- Lack of keratinized gingiva
- Abnormal color
What are the different types of gingival excess?
- Delayed passive eruption
- Pseudopocket
- inconsistent gingival margin
- gingival enlargement
How do abscess of the periodontium presents?
- circumscribed collection of purulence in periodontium
- fluctant on palpation
- incidental finding in early stages
- requires immediate treatment
What are the signs and symptoms?
- Rapid onset
- localized swelling
- usually painful: constant, easy to pinpoint
- Drainage- delay in treatment
- Radiographs- Often non-contributory, Bone loss not involving apical areas.
What are the classification based on location?
- Periocoronal abscess- tissue around the crown of partially erupted tooth
- Gingival abscess- occurs in the free gingval margin
- Periodontal abscess- tissues adjacent to periodontal pocket
Pericoronal Abscess is?
A localized infection of tissue around crown of partially erupted impacted tooth ( most common is 3rd molars)
- Gram negative anaerobes
- Food/debris entrapment under operculum
What are the signs and symptoms associated with pericoronal abscess ?
- Pain
- Edema
- Erythema
- Opposing molar tissue trauma
- Difficulty swallowing
- Limited mouth opening (TRISMUS)
- Fever and lymphadenopathy
What are the treatments for pericoronal abscess?
- Drainage
- irrigation with saline
- analgesics (painkiller)
- Antibiotics if infection severe or systemic involvement ( can spread to pharyngeal spaces
- Extraction
What is gingival abscess ?
- acute localized painful infection
- coronal location : free gingival margin, interdental papilla
- no signs of periodontitis
- caused by foreign objects (not cal)
- Develops rapidly
- Fluctuant in 24 to 48 hours
- Usually self limiting
What is the treatment for gingival abscess ?
- Removal of etiologic agent (debridement)
- Careful manipulation of tissue
- May require anesthesia
- Scaling establishes drainage through crevice
- Warm saline rinses
- Systemic antibiotics NOT indicated
What are periodontal abscess/ lateral abscess?
- Most common abcess involving periodontium
- Localized purulence within wall of periodontal pocket
- Common site: molar furcation areas deep pockets
What are the causes of periodontal abscess?
- Similar organisms as in periodontitis
- Gram negative anaerobic rods
What are the Gram negative anaerobic rods for periodontal abscesses?
- P gingivalis (most common)
- Prevotella intermedia
- Fusobacterium nucleatum
- Tannerella forsythia
- Aa not typically cultured
What are the common cause of periodontal abscess within a non-perio patient?
- Foreign objects
- Harmful habits
- Orthodontic factors
- Root surface alterations
What are the common cause of periodontal abscess within a perio patient?
- Disease exacerbation- complex pockets, furcations, vertical defects
- Post-scaling
- Post surgery
- Post medication
What happens with incomplete calculus removal with a periodontal abscess?
- Calculus removed from coronal aspect of deep pocket
- calculus remains deep due to difficult access
- Coronal tissue heals and tightens
- Prevents drainage of toxins and waste: abscess formation
What are the differential diagnosis for a periodontal abscess?
- periocoronitis
- endo-perio abscess
- pyogenic granuloma
- osteomylelitis
- odontogenic keratocyst
- Tumor lesion: metastic lesin, odontogenic myxomam non-hogkins lymphoma, squamous cell carcinoma
What is the occurrence of periodontal abscess?
- Obstruction
- Inability to drain/formation of fistuka
- Diabetics more susceptible
- Acute condition
What are the signs and symptoms of periodontal abscess?
- Pain and pressure
- Shiny mass
- Deep probing depths
- Mobility
- Tender to percussion
- Feels high
- Purulence on pressure
- Untreated or unresolved abscess
What is the treatment for periodontal abscess?
- First phase involves management of acute signs and symptoms: alleviate the pain, establish drainage, control spread
- Second phase (treatment of underlying perio lesions, pocket elimination): Subgingival debridement, soft diet, analgesics, saline rinse, antibiotics only if systemic involvement, surgery if no resolution, follow up
What are periapical abscess?
- Results from infection and death of pulp by toxins (non- vital)
- Trauma, caries or adjacent infected tooth
- Usually a radiolucency at apex
What are the different ways a periapical adbcess can drain?
- Drain via sulcus or fistula
- require endodontic treatment or extraction
If a periapical abscess is left untreated then it can?
- Lead to life threatening situations and death
What are the differences between periodontal abscess and periapical abscess
Periodontal
⚫ Foreign object
⚫ Preexisting pocket
⚫ Lateral radiolucency
⚫ Vital tooth
⚫ Fistula at lateral aspect of tooth
⚫ Swelling in attached gingiva
⚫ Dull pain/constant
⚫ Mild percussion pain
⚫ Mobility
Periapical
⚫ Associated with decay/ large
restoration
⚫ Usually no pocket
⚫ Apical radiolucency
⚫ Nonvital tooth
⚫ Fistula in apical area
⚫ Swelling at MGJ
⚫ Severe pain/ throbbing
⚫ Intermittent pain
⚫ Severe percussion pain
⚫ No or minimal mobility
What are endo-perio lesions?
- most periodontal and endodontic lesions ( exist independently from each other)
- Diagnostic challenge
What are some old category problems?
- Lesions may occur in subjects with or without periodontitis
- ** “Combined” too generic and not sufficiently descriptive for
- deciding treatment
Divisions
* Based on primary source of infection
* Relies on complete history
* Often unavailable to the clinician
* Treatment needs not relevant
* Both root canal and periodontal tissues require treatment
What are the new category lesions?
- Classified by signs and symptoms at presentation related to treatment:
Presence or absence of fractures / perforations
Presence or absence of periodontitis
Extent of periodontal destruction
What are signs of a endodontic lesion
- Necrotic pulp
- Chronic inflammation
- Border of lesion wider at apex
- Radiographs reveal isolated periodontal problem
- Drainage- Sinus tract through sulcus ,Pathway through PDL from apex orlateral canal
Communication through the apex or lateral canal can cause what because of drainage?
bifurcation involvement
What are the treatment for endodontic lesions?
- RCT and re-eval
- Closure of tract and elimination of probing depth indicates successful treatment
- Excellent prognosis
- No root planing when sinus tractalong PDL
Periodontal lesions can ?
- Can sometimes mimic endodontic lesions
- Observed on multiple teeth in generalized periodontitis
- Border of lesion wider at gingival margin
- Vital pulp
Periodontal Lesions can lead to ?
- Can lead to endodontic infection
: Periodontal lesion at cervical margin and Lateral canal exposed to oral environment
What are the main signs and symptoms for endo-perio lesions?
- Deep periodontal pockets near apex AND
- Negative or altered pulp vitality test
What are some other signs and symp for a endo-perio lesion?
- Bone resorption (apex or furcation)
- Palpitation pain
- Percussion pain
- Exudate
- Tooth mobility
- Sinus tract
- Gingival color change
What are the causes of a endo period lesion?
- Endodontic and/or periodontal infections
- Trauma and/or iatrogenic (treatment) factors
What are the main risk factors for endo perio lesion?
- Advanced periodontitis*
- Trauma
- Iatrogenic events
What are some other risk factors for endo-perio lesions?
- Groove presence* Palatal most common with non-perio
- furcation involvement*
- PFM crowns
- Active carious lesions
- = presence often worsen prognosis
What are the diagnosis and classifications for endo-perio lesion?
First Phase
* Patient history
* Identifies trauma occurrence and endodontics
* Clinical or radiographic exam
Second Phase
* Full-mouth periodontal assessment- PD, CAL, BOP, FG, MOD, etc
* Tooth vitality and percussion tests
What are the treatment for periodontal lesions?
- Periodontal therapy
- RCT not indicated unless vitality changes
- Periodic follow up to evaluate
- Retrograde (comes back) endodontic problems
Endodontic lesions respond well to conventional therapy like?
Debridement of pulp
Endodontic therapy
Periodontal component more difficult to treat because?
- Cannot resolve as long as endodontic lesion present
- Does not resolve as predictably as endodontic lesion
- The greater the periodontal involvement, the poorer the prognosis
