Perio Acute Diseases

Question 1

Define periodontal abscess

Answer 1

localised accumulation of pus in the gingival wall of the periodontal pocket

Question 2

List the symptoms of a periodontal abscess

Answer 2

ovoid swelling on lateral surface of root
BOP
Suppuration on probing
redness, swelling, pain
mobility
deep perio pocket
vital tooth

Question 3

List 5 differential diagnoses for a periodontal abscess, and the signs/symptoms that eliminates them as a possibility.

Answer 3

Gingival abscess
- superficial location, no bone loss
Peri-apical abscess
- non-vital tooth, apical lesion
Pericoronal abscess
- erupting tooth, no increased probing depth
Incomplete root fracture
- signs of fracture, hx of trauma
Endo perforation
- hx of endo treatment

Question 4

What are the 2 possible aetiologies in periodontal patients for periodontal abscess.

Answer 4

Acute exaceration in an untreated periodontal pocket/site non-responsive to perio treatment

Post S.P.T - calculus left in situ causing marginal blockage of pocket

Question 5

What are the aetiologies of a periodontal abscess in non-periodontal patients?

Answer 5

Impaction of foreign body (floss, food etc)
Harmful habit (nail biting)
Ortho - forces, cross bite trauma
Gingival hyperplasia
Alteration of root surface - grooves, perforation, root damage/ resorption

Question 6

Microbiology of periodontal abscess

Answer 6

gram -ve anaerobic rods

Question 7

4 steps to manage a periodontal abscess

Answer 7

1. drain access with hand instruments or incision into sulcus
2. Debridement
3. Systemic antibiotics - metronidazole
4. Exo tooth if bone levels unmaintainable

Question 8

Factors that may cause necrotising periodontal diseases

Answer 8

HIV/AIDS
immunosuppresion
malnourishment
severe viral infection
stress, nutrition, smoking in patients with gingivitis already present
previous NPD with residual craters

Question 9

List the 4 classification of necrotising periodontal diseases and briefly describe them.

Answer 9

1. Necrotising gingivitis - affects marginal gingival
2. necrotisin periodontitis - CAL associated
3. Necrotising stomatitis - extends beyond mucogingival junction
4. Noma/cancrum oris - invovles facial tissues

Question 10

List features of necrotising gingivitis

Answer 10

Pain
Gingival ulcers - punched out at gingival margin
spontaneous bleeding
white/yellow pseudomembrane
halitosis
lymphadenopathy
fever/malaise

Question 11

List features of necrotising periodontitis

Answer 11

Loss of attachment
deep interproximal craters (divide papilla into facial and lingual)
sequestre of necrotic bone

Question 12

Acute phase treatment of necrotising periodontal disease

Answer 12

pain relief
gentle debridement under LA
Chx mouthrinses
gentle OH
Metronidazole 200mg three/day for 5 days

Question 13

Maintenance phase treatment for necrotising periodontal disease

Answer 13

treat pre-existing periodontal disease
correct craters
check HIV status