Perio-Endo and Perio abscesses Flashcards
What is an abscess?
A pus-filled vesicle (inflammatory exudate, dead and dying neutrophils that have flooded into an area in attempt to neutralise infection) in periodontium coming from a non-vital tooth
Localised swelling
What is pericoronitis?
Infection surrounding wisdom teeth
What are the 4 types of abscesses of the periodontium?
Gingival abscess
Periodontal
Peri-coronal
Endo-perio lesion
What are the SDCEP guidelines for management of an acute periodontal abscess?
Careful sub-gingival instrumentation of perio pocket (may require LA)
If pus present, drain through incision or through the pocket.
Recommend optimal analgesia
DO NOT prescribe antibiotics unless spreading infection or systemic risk.
Review and carry out perio instrumentation at later appointment.
If prescribing antibiotics for treatment of periodontal abscess what is dose?
Penicillin V 250mg 5 days
OR
Amoxicillin 500mg 5 days
OR
Metronidazole 400mg 5 days
What are signs/ symptoms of periodontal abscess?
Swelling
Pain
TTP in LATERAL DIRECTION
Deep periodontal pocket
Bleeding
Suppuration (pus) - IF NOT SUPPURATION = NO ABSCESS
Enlarged regional lymph nodes
Commonly existing perio disease
Tooth usually VITAL
What are the signs/ symptoms of perio-endo lesion?
Deep periodontal pockets reaching or close to apex
Negative or altered response to pulp vitality tests
Bone resorption in apical or furcation region
Spontaneous pain
Pain on percussion and palpation
Mobility
Sinus tract
How can exposed dentinal tubules cause inflammation of pulp?
Dentine is porous and tubules have a direct communication between pulp and external tissues.
If dentine infected - can travel to pulp
What are some causes of perforation?
Extensive dental caries
Resorption
Operator error - root canal instrumentation or post prep
What are some trauma or iatrogenic factors that cause endo-perio lesions?
Root/ pulp chamber/ furcation perforation
Root fracture or cracking
External root resorption
Pulp necrosis draining through periodontium
How should perio-endo lesions be treated?
Carry out endo treatment of affected tooth
Recommend optimal analgesia
DO NOT prescribe antibiotics
Recommend use of 0.2% chlorhexidine mouthwash until acute symptoms subside
Review within 10 days of acute management
What is a gingival abscess?
localised to gingival margin (localised food packing)
What is a perio-endo lesion?
tooth is suffering from varying degrees of endodontic and periodontal disease symptoms - acute or chronic
What is a periodontal abscess?
usually in perio patients, relating to pre-existing deep pockets. Food packing and bacteria packed into pocket and is sealed due to partial healing of pocket post HPT.
What is a peri-coronal abscess?
Associated with partially erupted tooth - most commonly 8’s
