Perio-endo And Periodontal Abscess

Question 1

What is a periodontal abscess?

Answer 1

Infection in periodontal pocket which can be acute or chronic causing rapid destruction of periodontal tissues and a large negative prognosis of the affected tooth

Question 2

Signs and symptoms of an abscess?

Answer 2

Swelling of gingiva

Pain

TTP laterally

Mobility

Deep pocketing with Bleeding and Suppuration

Malaise / lymphadenopathy

Question 3

How would you treat a periodontal abscess?

Answer 3

Careful sub gingival instrumentation with LA

If pus present, drain

Give antibiotics only if signs of spreading infection or patient is systemically unwell

Use .2% chlorhexadine until symptoms subside

Review and Carry out further instrumentation at appropriate recall interval

Question 4

What antibiotic could you give for an abscess if indications implied use?

Answer 4

Penicillin V, 500mg 4 times per day for 5 days

Question 5

What is an endo-perio lesion?

Answer 5

Pathological communication between Endodontics and perio tissues of the tooth

Question 6

What are some symptoms and signs of an endo-perio lesion?

Answer 6

Deep pockets close to apex

Negative or altered response to vitality testing

Bone resorption apically

Spontaneous pain

Pain on palpation and percussion

Mobility

Draining sinus

Colour alterations of crown

Question 7

What are the ways infection can communicate between pulpal tissues and the periodontium?

Answer 7

Lateral and accessory canals - often found at the apical third of tooth root

Furcation canals - can communicate with furcation and peri-radicular tissues

Question 8

What ways can infection communicate between endo and perio lesions

Answer 8

Lateral and accessory canals - apical 1/3 of root mainly

Furcal canals - leading to peri radicular tissues

Apex of tooth - most common

Perforation - extensive caries, resorption, operator error

Developmental grooves

Question 9

What trauma may cause an endo-perio lesion?

Answer 9

Root or pulp chamber perforation due to operator error

Root fracture or cracking due to trauma or OE

External root resorption due to trauma

Pulpal necrosis draining through periodontium

Question 10

How would you treat a perio-endo lesion?

Answer 10

Carry out endo treatment

Only give antibiotics if systemically unwell or infection spread

.2% chlorhexadine until acute subside

Review 10 days and carry out supra and sub gingival scaling then review

Question 11

Does endo disease affect periodontal health?

Answer 11

Infected pulp exhibits inflammatory response on PDL and at apical foramen