Perio endo

Question 1

gingival abscess

Answer 1

localised to gingival margin

Question 2

what teeth are usually affected by a periodontal abscess

Answer 2

those with a pre existing deep pocket
also associated with food packing and tightening of gingival margins post HPT (bacteria remaining cant escape as easy)

Question 3

what teeth are usually affected by a peri coronal abscess

Answer 3

partially erupted teeth
most commonly 8s

Question 4

signs and symptoms of a periodontal abscess

Answer 4

swelling, pain , bleeding, TTP in lateral direction, fever, enlarged lymph nodes, suppuration
tooth is usually vital

Question 5

what are the SDCEP guidelines on managing a periodontal abscess

Answer 5

• if pus present , drain via incision or via periodontal pocket
• carry out subgingival scaling just short of pocket base (may need LA)
• recommend analgesia and use of chlorhexidine 0.2% until acute symptoms pass
• after acute management, review and carry out definitive perio instrumentation

Systemic antibiotics should only be given if there are signs of systemic infection or if the symptoms have not been resolved by local measures.

Question 6

If a dental abscess has not been resolved locally or there are signs of systemic spread what would your antibiotic of choice be

Answer 6

amoxicillin 500mg , 3x daily, 5 days
must be done in conjunction with mechanical therapy

Question 7

what 4 components make up the periodontium

Answer 7

gingiva, PDL, cementum and alveolar bone

Question 8

what is seen in a perio-endo lesion

Answer 8

pathological communication between the endodontic and periodontal tissues of a tooth

Question 9

signs and symptoms of a perio-endo lesion

Answer 9

deep perio pocket nearing tooth apex
negative or altered response to vitality testing
bone resorption in apical or furcation regions
spontaneous pain
pain on palpation / percussion
pus
tooth mobility
sinus tract
crown and gingival discolouration

Question 10

via what might pathology in perio-endo lesions communicate

Answer 10

apex and PDLS, lateral or furcal canals that have been exposed due to recession

Question 11

what occurs as a result of perforation and how might it occur

Answer 11

results in communication between the root canal system and either periradicular tissues, PDLs or oral cavity
can occur due to extensive caries, resorption or operator error during RCT

Question 12

how does SDCEP recommend treating a tooth affected by a perio-endo lesion

Answer 12

carry out endo of affected tooth
recommend analgesia
recommend chlorhexidine 0.2% mouthwash until symptoms pass
review within 10 days and perform supra and sub gingival scaling
only systemic antibiotics if sign of infection
may require surgical instrumentation