Perio-Endo and Periodontal Abscess

Question 1

What are the different abscesses of the periodontium

Answer 1

Gingival abscess
Periodontal abscess
Periocoronal Abscess
Endodontic periodontal lesion

Question 2

What is a gingival abscess

Answer 2

An abscess Localised to gingival margin in space between tooth and gum

Question 3

What is a periodontal abscess

Answer 3

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

Question 4

What is a pericoronal abscess

Answer 4

An abscess associated with partially erupted tooth most commonly 8s

Question 5

What is a endodontic periodontal lesion

Answer 5

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”

Question 6

How much of dental emergincies is for periodontal abscesses

Answer 6

approximately 7.7–14.0%

Question 7

What happens in a periodontal abscess

Answer 7

Rapid destruction of periodontal tissues, with a negative effect on the prognosis of the affected tooth

Question 8

What % of teeth found with a perio abscess are extracted

Answer 8

45%

Question 9

What are the signs and symptoms of perio abscess

Answer 9

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

Question 10

What are the SDCEP guidlines when dealing with a perio abscess

Answer 10

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.

Question 11

When would you use systemic antibiotics in a perio abscess case and what antiobiotics would you use and how much

Answer 11

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

Question 12

What are the signs and symptoms of a perio-endo lesion

Answer 12

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

Question 13

In a perio Endo lesion what are the possible routes of communication

Answer 13

Exposed dentinal tubules
Lateral and accesssory canals
Furcal canals
Apical foramen
Perforation
Developmental groove

Question 14

How do the possible routes of communication in an Perio Endo lesio work

Answer 14

They allow bi-directional spread of infection and/or inflammation

Question 15

What are the classifications of a perio endo lesion

Answer 15

A carious lesion affecting the pulp and secondarily the periodontium

Periodontal destruction that secondarily affects the root canal

or by both concomitantly

Question 16

How do dentinal tubules act as a possible route of communication

Answer 16

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

Question 17

What are the stats for teeth with accessory canals

Answer 17

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

Question 18

Do all furcal canal reach the pulp chamber

Answer 18

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

Question 19

Pulp inflammation and a furcal canal can lead to what

Answer 19

Pulpal inflammation may cause an inflammatory reaction in the interradicular periodontal tissues

Question 20

What else can associate with endo-perio lesions and list them

Answer 20

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

Question 21

What are the SDCEP guidlines for treatment of a perio endo lesion

Answer 21

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

Question 22

What is the treatment of a perio endo lesion

Answer 22

Primary endodontic therapy first

Then peridontal therapy (OHI etc)

and then surgical investigation and treatment

Question 23

Does endodontic disease affect periodontal health?

Answer 23

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

Question 24

Does periodontal disease affect endodontics?

Answer 24

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.