Perio Endo

Question 1

What are the 4 types of abscesses of the periodontium?

Answer 1

Gingival abscess - limited to gingival tissue

Pericoronal abscess - associated with a. Partially erupted tooth (usually 8’s)

Periodontal - usually related to pre-existing deep pocket/ food packing/ tightening of gingival margin post HPT

Endodontic-periodontal - tooth is suffering from endo and perio disease

Question 2

What is the treatment of a periodontal abscess and what guidelines does this follow?

Answer 2

SDCEP guidelines

Careful subgingival instrumentation short of the base of the pocket
Drain pus by incision/ through pocket
Only prescribe antibiotics if signs of spreading infection/ systemic involvement (penicillin 250 mg/ amoxicillin 500mg for 5 days or metronidazole 400mg for 5 days)

Recommend optimal analgesia, use of 0.2% chlorhexidine mouthwash until symptoms subside

Question 3

Define Endo-periodontal lesions?

Answer 3

Pathological communication between the endodontic and periodontal tissues of a given tooth.

Can be by a various lesion that affects the pulp and secondarily, affects the periodontium
Or
By the periodontal destruction that secondarily affects the root canal
Or
By both occurring at the same time

Question 4

What are possible causes of an actuare perio-endo lesion?

Answer 4

Trauma (root fracture, external root resorption, pulp necrosis)
Perforation

Question 5

What are the possible causes of chronic perio-endo lesions?

Answer 5

Pre-existing periodontitis
Slow and chronic progression without evident symptoms eg. exposed lateral canal/ furcal canal (furcation of molars)

Question 6

What is a perforation?

Answer 6

Can be caused by dental caries, resorption or operator error during RCT/ post prep

Results in communication between the root-canal system and either peri-radicular tissues, periodontal ligament or in the oral cavity.

Question 7

What is the role of a developmental groove in perio-endo lesions?

Answer 7

An invagination common in upper incisors - vertical development radicular groove.

If the epithelial attachment is breached, the groove becomes contaminated and a self-sustaining infra bony pocket can form along its entire length.

This creates a channel for accumulation of bacterial biofilm and a route of progression for periodontitis (can also affect pulp if extends beyond the apex)

Area of bone destruction follows the course of the groove

Question 8

What is the treatment of perio-endo lesions according to SDCEP?

Answer 8

Carry out endo treatment

Recommend optimal analgesia and 0.2% chlorohexidine mouthwash until acute symptoms subside (10ml 2x daily)
Do not prescribe antibiotics unless indication of systemic involvement/ spreading

Review in 10 days
Supra and subgingival instrumentation if necessary

Question 9

Is there a link between endo and perio disease?

Answer 9

Endo infected molars are more associated with bone loss in furcal area
May enhance periodontitis by spreading pathogens through accessory canals and dental tubules.

The pulp is not usually affected by perio disease until recession affects a lateral/ accessory canal (this only occurs if not protected by cementum/ blood supply at apical foramen remains in tact)

Question 10

What are some uses of chlorohexidine?

Answer 10

To treat:
Periodontal disease
Candida infection
Oral mucositis
Post surgical antiseptic