Perio-Endo and Periodontal Abscess Flashcards
What are the different abscesses of the periodontium
Gingival abscess
Periodontal abscess
Periocoronal Abscess
Endodontic periodontal lesion
What is a gingival abscess
An abscess Localised to gingival margin in space between tooth and gum
What is a periodontal abscess
Infection in a periodontal pocket which can be acute or chronic and asymptomatic if freely draining
usually related to pre-existing deep pocket also associated with food packing and tightening of gingival margin post HPT, forms in periodontal pocket
What is a pericoronal abscess
An abscess associated with partially erupted tooth most commonly 8s
What is a endodontic periodontal lesion
when the tooth is suffering from varying degrees of endodontic and periodontal disease
“EPL is a pathological communication between the endodontic and periodontal tissues of a given tooth”
How much of dental emergincies is for periodontal abscesses
approximately 7.7–14.0%
What happens in a periodontal abscess
Rapid destruction of periodontal tissues, with a negative effect on the prognosis of the affected tooth
What % of teeth found with a perio abscess are extracted
45%
What are the signs and symptoms of perio abscess
Swelling
Pain
Tooth may be TTP in lateral direction
Deep periodontal pocket
Bleeding
Suppuration
Enlarged regional lymphnodes
Fever
Tooth usually vital
Commonly pre-existing periodontal disease
What are the SDCEP guidlines when dealing with a perio abscess
Carry out careful sub-gingival instrumentation short of the base of the periodontal pocket to avoid iatrogenic damage; local anaesthesia may be required.
If pus is present in a periodontal abscess, drain by incision or through the periodontal pocket.
Recommend optimal analgesia.
Do not prescribe antibiotics unless there are signs of spreading infection or systemic involvement.
Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.
Following acute management, review and carry out definitive periodontal instrumentation and arrange an appropriate recall interval.
When would you use systemic antibiotics in a perio abscess case and what antiobiotics would you use and how much
Only if signs of spread and systemic effects or if symptoms do not resolve with local measures
Careful RSD
Penicillin V 250mg(preferred) or Amoxicillin 500mg 5 days
Or
Metronidazole 400mg 5 days
MUST only be used in conjunction with mechanical therapy in order to reduce the bacterial load and disrupt the biofilm
What are the signs and symptoms of a perio-endo lesion
deep periodontal pockets reaching or close to the apex
negative or altered response to pulp vitality tests
bone resorption in the apical or furcation region
spontaneous pain
Pain on palpation and percussion
Purulent exudate
tooth mobility
sinus tract
crown, and gingival colour alteration
In a perio Endo lesion what are the possible routes of communication
Exposed dentinal tubules
Lateral and accesssory canals
Furcal canals
Apical foramen
Perforation
Developmental groove
How do the possible routes of communication in an Perio Endo lesio work
They allow bi-directional spread of infection and/or inflammation
What are the classifications of a perio endo lesion
A carious lesion affecting the pulp and secondarily the periodontium
Periodontal destruction that secondarily affects the root canal
or by both concomitantly
How do dentinal tubules act as a possible route of communication
Dentin is highly permeable with the tubules as the major channels for diffusion of material across dentin,
application of soluble material from bacterial plaque to exposed dentin can cause pulpal inflammation (Bergenholtz and Lindhe) suggesting there is a way for bacterial plaque to cross through the tubules
What are the stats for teeth with accessory canals
30–40% of all teeth have lateral and accessory canals, majority are found in the apical third of the root.
17% of teeth presented multiple canal systems in the apical third of the root, about 9% in the middle third and fewer than 2% in the coronal third
Do all furcal canal reach the pulp chamber
No
The incidence of furcal canals may vary from 23% to 76%. Not all of these canals extend the full length from the pulp chamber to the floor of the furcation
Pulp inflammation and a furcal canal can lead to what
Pulpal inflammation may cause an inflammatory reaction in the interradicular periodontal tissues
What else can associate with endo-perio lesions and list them
Trauma and iatrogenic factors
root/pulp chamber furcation perforation (e.g. because of root canal instrumentation or to tooth preparation for post‐retained restorations)
root fracture or cracking (e.g., because of trauma or tooth preparation for post‐retained restorations)
external root resorption (e.g., because of trauma)
pulp necrosis (e.g., because of trauma) draining through the periodontium
What are the SDCEP guidlines for treatment of a perio endo lesion
Carry out endodontic treatment of the affected tooth.
Recommend optimal analgesia.
Do not prescribe antibiotics unless there are signs of spreading infection or systemic involvement.
Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.
Following acute management of the lesion, review within ten days and carry out supra- and sub-gingival instrumentation if necessary and arrange an appropriate recall interval
What is the treatment of a perio endo lesion
Primary endodontic therapy first
Then peridontal therapy (OHI etc)
and then surgical investigation and treatment
Does endodontic disease affect periodontal health?
When the pulp becomes infected, it elicits an inflammatory response in the periodontal ligament at the apical foramen and/or adjacent to openings of the small portals of exit
Does periodontal disease affect endodontics?
Pulp is usually not significantly affected by periodontal disease until recession affects a lateral or accessory canal to the mouth.
Bacteria access through the lateral or accessory canal into the pulp causing chronic inflammation and possibly pulp necrosis.
If the lateral or accessory canals are protected by cementum, necrosis usually does not occur. If the blood supply from the apical foramen is still intact, the pulp will remain vital
Pathogenic invasion and secondary inflammation and necrosis of the pulp can occur if during scaling, curettage or periodontal surgery accessory canals are severed and/ or opened to the oral environment.
