Perio-Endo and Periodontal Abscess Flashcards
What are the types of abscesses of the periodontium?
Gingival abscess: Localized to the gingival margin.
Periodontal abscess: Related to deep pockets, food packing, or post-HPT gingival tightening.
Pericoronal abscess: Associated with partially erupted teeth, most commonly third molars.
Endodontic-Periodontal Lesion: Involves varying degrees of endodontic and periodontal disease.
Define a periodontal abscess and its clinical significance.
what does it account for
A periodontal abscess is an infection in a periodontal pocket that may be acute or chronic. It can be asymptomatic if draining freely and contributes to rapid periodontal tissue destruction, negatively affecting the prognosis of the affected tooth. It accounts for 7.7–14.0% of all dental emergencies.
What are the signs and symptoms of a periodontal abscess?
Swelling, pain
Tooth tender to percussion laterally
Deep periodontal pockets
Bleeding, suppuration
Enlarged regional lymph nodes, fever
Tooth usually remains vital
Commonly occurs with pre-existing periodontal disease
How should an acute periodontal abscess be managed according to SDCEP
Perform subgingival instrumentation short of the pocket base (local anesthesia may be needed).
Drain pus via incision or through the periodontal pocket.
Recommend optimal analgesia.
Avoid antibiotics unless systemic involvement or spreading infection is present.
Advise 0.2% chlorhexidine mouthwash until symptoms subside.
Review and perform definitive periodontal instrumentation after acute phase.
When should systemic antibiotics be prescribed for a periodontal abscess?
what are the options
Only if there are signs of systemic spread or if local measures fail. Options:
Penicillin V 250 mg or Amoxicillin 500 mg for 5 days.
Metronidazole 400 mg for 5 days.
Must be combined with mechanical therapy to disrupt biofilm.
What is an Endo-Periodontal Lesion (EPL)?
A pathological communication between the endodontic and periodontal tissues of a given tooth.
What are the causes of acute and chronic EPL?
acute, chronic
Acute: Trauma, perforation.
Chronic: Pre-existing periodontitis, slow progression without evident symptoms.
What are the signs and symptoms of EPL?
Deep periodontal pockets reaching or near the apex
Negative/altered pulp vitality test
Bone resorption in the apical or furcation region
Spontaneous pain, pain on palpation/percussion
Purulent exudate, tooth mobility, sinus tract
Crown/gingival color alterations
What are the possible routes of communication between pulp and periodontium?
Exposed dentinal tubules
Lateral and accessory canals
Furcal canals
Apical foramen
Perforations (causes - extensive caries, resorption, iatrogenic)
Developmental grooves
What is the primary route of communication between pulp and periodontium?
The apical foramen, through which microbial and inflammatory by-products can pass.
How can developmental grooves contribute to periodontal disease?
If epithelial attachment remains intact, the periodontium stays healthy, but if breached, bacterial biofilm accumulates, leading to an infrabony pocket and possible pulpal involvement if it reaches the apex.
Radiographically, the area of bone destruction follows the course of the groove
usually central incisors
What is the current classification of endo-periodontal lesions?
A carious lesion that affects the pulp and secondarily affects the periodontium.
Periodontal destruction that secondarily affects the root canal.
Both events occurring at the same time.
How should perio-endo lesions be treated according to SDCEP?
Perform endodontic treatment first.
Recommend analgesia.
Avoid antibiotics unless systemic spread is present.
Use 0.2% chlorhexidine mouthwash until symptoms subside.
Review within 10 days and perform supra-/subgingival instrumentation if necessary.
What additional treatments are available for EPL?
Surgical debridement often needed (scaling alone is insufficient).
Guided tissue regeneration.
Use of Emdogain (enamel matrix protein derivative) to promote regeneration.
How does endodontic disease affect periodontal health?
Infected pulp elicits an inflammatory response in the periodontal ligament, leading to interradicular bone loss. If endodontic treatment fails, marginal bone loss may increase.
What did Jansson et al.’s study conclude about endodontic infection and periodontitis?
Patients with failed endodontic treatment had ~3x more marginal bone loss.
Endodontic infection in mandibular molars was linked to more attachment loss in the furcal area.
Successfully treating endodontic infections resolved periodontal issues.
What is the final conclusion on perio-endo relationships?
accessory lateral
Pulp health is generally unaffected unless:
- There is exposed lateral or accessory canals due to recession, perforation, or aggressive treatment.
Vital pulp maintained if:
- Cementum layer intact over canals.
- Apical blood supply preserved.
Aggressive periodontal therapy (e.g. curettage, surgery) can expose canals → Potential for secondary pulpal infection.
