Perio Flashcards
Periodontal abscess / 6mins
A 50 year old male patient attended for HPT with hygienist 3 months ago , their 35 is tender and has a swelling around the tooth and has an 8mm pocket distally as well as suppuration
The patient is systematically well and has a normal body temperature
Provide your diagnosis to the patient and discuss how would you like to investigate the matter further?
- Start by saying what u
“ I can see an abscess but we have two types of abscess so we need to take further tests to confirm the correct diagnosis and then treat it the right way “ - Ask examiner for sensibility testing and a PA radiograph
EPT 35 and 36 are positive and PA shows periodontal/periapical pathology
” due to the swelling + the presence of a pocket with pus + bone loss from radiograph I can confirm that the diagnosis is a periodontal abscess”
” This can be associated with food packing and tightening of the gum following periodontal therapy , also it is TTP in a lateral direction, deep pockets are present with bleeding and pus formation , usually the tooth is vital (alive) and is commonly associated with a pre-existing periodontal disease “
- Treatment
1. Irrigate through pocket
2. debridement
3. hot salty mouthwash and analgesia
In detail :
Subgingival instrumentation short of the base of the pocket , drain pus by incision or through the pocket , CHX mouth was and analgesia
XLA tooth if hopeless prognosis
Arrange recall to see patient again to start periodontal therapy and review abscess
” you will not need any antibiotics since it is a localised infection
Localised aggressive periodontitis (6 mins)
Diagnose from OPT and explain diagnosis and management
- start by telling the patient the radiographic and clinical findings, explain diagnosis and stage drade of periodontitis
- Features
~ patient generally fit and well / young
~ associated with a family history of aggressive periodontitis
~ rapid loss of attachment which is not proportional to the level of plaque present
~ Localised if only 6s and incisors affected with less than 2 other teeth , can start in puberty, robust antibody response
~ Generalised if 3 teeth involved other than 6s and incisors , pt under the age of 30 , episodic nature of destruction with poor antibody response
~ associated with Papillon-Lefèvre syndrome (PLS) (inherited disease)
- Tell patient about the disease
~ evidence that it is more common in people with a genetic predisposition to periodontal disease
~ other factors such as smoking and poor OH have an impact
~ it is important to screen and monitor close relatives with a patient with severe periodontitis
~ Discuss prognosis of teeth with regard to loss of attachement , mobility and furcation involvement
~ emphasise to pt that it is still treatable as they may lose hope - Treatment
~ needs thorough self care ( OHI instruction using TIPPS) ; F toothpaste, ID brushing , MW use
~ periodontal treatment (surgical and non surgical as required)
~ Diet diary
~ 2 weeks of CHX mouthwash (daily)
~ Abs not routinely used as first line but can be used as an adjunct ( Pen v or Metro) ; it show good results but sometimes does not treat the cause as it fails to disrupt the biofilm as low proportion reach the site of infection
~ if tx does not work in 3 months then the pt should be referred to secondary care
~ emphasise the need of regular checkups as there is a risk of recurrence
ABs side effects include vomitting / abs resistance / nausea
ANUG / 6 mins
30-year old patient (not registered with GDP)
C/O signs of ANUG
Smokes 20 cigs a day
Otherwise fit and well
Has cervical lymphadenopathy
Discuss diagnosis with patient and proposed treatment plan
( no need to obtain more information from the patient )
- Introduce yourself and designation
- Take a brief history
“ can you tell me what is going on? , are in pain? any bleeding? “
ask about systemic symptoms , stress , OH and smoking - Explain diagnosis
“ Mr X i am afraid you are suffering from a condition called acute necrotising ulcerative gingivitis or ANUG which is a rare condition presenting as an acute form of gum disease, which means that the gum disease progress and develop much faster than normal gum disease, the ulcers are due to bacteria breaking down gum tissue “ - Explain aetiology
“ it can be caused by a variety of reason but it tends to cluster in people who are stressed , smokers or poorly nourished “
” Poor OH and immunocompromised (HIV) pts have a higher risk of developing it “
- Explain symptoms
“ Common symptoms include
1. bleeding
2. painful gums
3. painful ulcers at the tip of the papillae
4. receding gums between teeth
5. bad breath
6. metallic taste in mouth
7. excess saliva
8. difficulty speaking or swallowing “
9. punch out appearance with gre pseudomembrane
” The disease can also extend beyond the mouth and cause systemic symptoms like swollen lymph nodes or a high temperature”
- Discuss management
1. reassure it can be managed with local measures
2. good OHI
3. NSPT under LA
4. MW such hydrogen peroxide 6% or CHX 0.2%
5. smoking cessation
6. stress reduction
7. due to systemic involvement ; 3 day regimen of metro
8. analgesia
9. advise to register with GDP
~ review pt within 10 days
~ it can recurr so it is important to manage risk factors
ANUG is a Fusospirocheteal infection
Comparing pre and post treatment pocket charts ( 12 mins)
Indicate where healing has occurred , where it hasn’t and reasons for failure
- Missing teeth - identify causes
- Gingival margin - from ACJ , to incdicate recession
- Probing depths - indicates treatment difficulty
- LOA - indicated deverity of disease
- Bleeding on probing - indicates disease activity
- Mobility - poor prognosis and may give rise to symptoms
- Furcation - treatment difficulty
- Reasons for failure?
1. Patient factors
~ not compliant with OH
~ MH - diabetes, immunocompromised , pregnant, poor diet
~ SH - smoking and stress
~ Pt unable to carry out OH effectively due to dexterity issues ( PArkinsons or dementia pts) or hard to reach areas such as wisdom tooth or furcation area
- Clinician factors
~ inadequate debridement
~ low experience
~ inability to disrupt biofilm - Tooth related factors
~ Overhangs and poor margins
~ Root morphology , furcation, vertical bony defect making it hard to access for debridement
~ very deep pockets
Healing = no BOP , 4mm or less probing depths
Why is smoking a risk factor for periodontal disease?
- Reduced gingival blood flow
- impaired wound healing
- Impaired white cell function
- Increased production of inflammatory cytokines which increase tissue destruction
Why is diabetes a risk factor for periodontal disease?
- Poor wound healing
- Immunosupressed - poor inflammatory response
- AGE products increase inflammation
- Neutrophils defects
