Perio Flashcards
30yo pt signs & symptoms of ANUG. smokes x20/daily, otherwise fit & well. cervical lymphadenopathy. DWP & proposed mx
dx - acute necrotising ulcerative gingivitis; rare condition that occurs when gum disease develops much faster & more severely than normal
more likely if poor OH, stress, smoking, immunocompromised, malnourished
symptoms - bleeding / painful gums, ulcers, receeding gums, bad breath, metallic taste in mouth, excess saliva, difficulty speaking or swallowing
disease can spread from mouth causing systemic symptoms such as swollen lymph nodes or fever
mx = reassurance
OHI, HPT inc RSD sub gingival PMPR under LA & MW CHX0.2% or H2O2 6% & smoking cessation
as systemic symps give ABX
1. metronidazole 400mg 1x3 daily for 3 days send 9 tabs
2. amoxicillin 500mg 1x3 daily for 3 days send 9 tabs
recommend optimal analgesia, advise to register with GDP, rv within 10days & referral if no changes in RV
dx, mx & explanation of aggressive perio
features -
- young cohort of pts usually clinically healthy
- associated with genetic link i.e. family hx
- possible link with inherited dx such as PLS
- link with smoking
dental health -
- rapid disease progression
- rapid LoA & bone / CT destruction
- low / inconsistent levels of plaque bacteria present
- root abnormalities
- defects in neutrophil function
- hyper responsive macrophage phenotype
- increased A.a.
pattern -
localised = circum pubertal onset / localised LoA, affects 6s & incisors, robust antibody response
generalised = affects pts u30, generalised LoA, affects 3 teeth other than 6s & incisors, clear episodic nature of destruction of periodontal attachment & associated structures, poor antibody response
DWP - convincing evidence of genetic predisposition of perio, particularly aggressive form, ask re family hx, other risks inc smoking, poor OH, dwp prognosis of teeth re LoA, mobility & furcation involvement, important to screen & monitor siblings & children. emphasise it is treatable with good OH & reducing modifiable risk factors
tx =
- OHI via TIPPS
- HPT step 1-4 BSP guidelines
- 2wks of CHX MW & spray
- no need for ABX as 1st line tx
- if no change after 3mths pt should be referred to specialist if they have adhered to optimum OH & dealt with risk factors
compare pre & post perio tx pocket charts; indicate where healing has occurred, where it hasn’t & reasons for failure
missing teeth - identify causes
gingival margin - from ACJ, recession
probing depths - indicator of tx difficulty
LoA - indicator of severity of dx
bleeding on probing - indicator of disease activity
furcation - indicator of tx difficulty
mobility - gives rise to symptoms & poorer prognosis
reasons for failure = smoking / non compliance / poor OH / inability for pt to practice OH effectively i.e. hard to reach areas such as furcations & lone standing teeth or poor manual dexterity i.e. parkinson’s, dementia, age / systemic factors; stress, diabetes, pregnancy, malnutrition, poor diet / difficulty accessing for debridement or inadequate debridement i.e. time constraint, pt cannot tolerate / iatrogenic factors e.g. overhangs, poor margins
50yo pt attended for step 3 approx 3mths ago. 35 is tender, swelling around tooth & 8mm distal pocket with suppuration. pt systemically well & normal temp. give dx to pt, special investigations & mx
ask for PA radiograph & sensibility tests otherwise you won’t get them
EPT 35 & 36 respond positively
PA radiograph shows PA pathology
swelling / pocket with pus / bone loss from radiograph
dx = periodontal abscess
tx -
irrigate through pocket
debridement
hot salty MW
no ABX since localised infection
