Other Periodontal Disease 2

Question 1

what types of abscesses of the periodontium can you get?

Answer 1

Gingival abscess: localised to gingival margin

Periodontal abscess: usually related to preexisting deep pocket also associated with food packing and tightening of gingival margin

Pericoronal abscess: associated with partially erupted teeth - usually the 8s

Endodontic-Periodontal Lesion: tooth is suffering from varying degrees of endodontic and periodontal disease

Question 2

what are the general signs & symptoms of a periodontal abscess?

Answer 2

• swelling
• pain
• tooth may be TTP in lateral direction
• deep periodontal pocket
• bleeding
• enlarged regional lymph nodes
• fever
• tooth usually vital
• commonly pre-existing periodontal disease

Question 3

what do SDCEP guidelines say on treating periodontal abscesses?

Answer 3

• carry out careful sub-gingival PMPR (may need LA)
• If puss present, drain
• DONT PRESCRIBE antibiotics unless signs of spreading infection
• Recommend 0.2% chlorhexidine MW until acute symptoms face
• after acute management, review & carry out definitive periodontal PMPR and arrange appropriate recall interval

Question 4

what is an endodontic-periodontal lesion?

Answer 4

EPL is a pathological communication between the endodontic & periodontal tissues of a given tooth

Question 5

what is the main route of communication between the pulp and the periodontium?

Answer 5

apical foramen, microbial & inflammatory by-products may exit here causing periradicular pathology

Question 6

what is meant by perforation?

Answer 6

communication between the root-canal system and either periradicular tissues (periodontal tissues or the oral cavity)

Question 7

what is the definition of periradicular?

Answer 7

refers to the structures and tissues that surround the root

(PDL, cementum, alveolar bone etc)

Question 8

what are causes of perforation?

Answer 8

• extensive dental caries
• resorption
• operator error (during RCT instrumentation)

Question 9

what do the SDCEP guidelines say for treatment of perio-endo lesions?

Answer 9

• carry out endodontic tx of affected tooth
• optimal analgesia
• no antibiotics unless spreading infection or systemic
• 0.2% CHD mouthwash
• review within 10 days and carry out supra & sub PMPR if needed