Perio-Endo and Periodontal Abscess

Question 1

What are the different types of periodontium abscesses

Answer 1

gingival abscess
periodontal abscess
pericoronal abscess
Endodontics periodontal lesion

Question 2

What is gingival abscess

Answer 2

localized to gingival margin

Question 3

What are the most common causes of gingival abscesses

Answer 3

trauma
food impaction
recent surgery
can result in localized infection in gingiva but is not associated with periodontal disease

Question 4

What are periodontal abscess usually related to

Answer 4

usually related to pre-existing deep pocket also associated with food packing and tightening gingival margin post HPT

Question 5

What are pericoronal abscess associated with

Answer 5

associated with partially erupted tooth, most commonly 8s

Question 6

What are Endodontics periodontal lesions

Answer 6

tooth is suffering from varying degree of Endodontics and periodontal disease

Question 7

What is a periodontal abscess

Answer 7

infection in a periodontal pocket which can be acute or chronic and asymptomatic if free draining

results in rapid destruction of periodontal tissues with a negative effect

Question 8

What are signs and symptoms of periodontal abscess

Answer 8

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 9

What does SDCEP guidelines say about tx of periodontal abscess

Answer 9

carry out sub gingival instrumentation short of base of pocket
if pus is present then drain by incision or through the pocket
recommend optimal analgesia
do not prescribe AB unless signs of spreading infection or systemic involvement
recommend use of 0.2% chlorhexidine mouthwash until acute symptoms subside
following acute management, review and carry out definitive periodontal instrumentation and arrange an appropriate recall interval

Question 10

When can we prescribe AB for periodontal abscess

Answer 10

only if signs of spread and systemic effects or if symptoms do not resolve with local measures
has to use in conjunction with careful RSD

Question 11

What AB do we prescribe for periodontal abscess

Answer 11

amoxycillin 500mg 5 days TID

OR

metronidazole 400mg 5 days TID

Question 12

What are endo-periodontal lesions

Answer 12

pathological communication between Endodontics and periodontal tissue of a given tooth

Question 13

What are causes of acute endo periodontal lesions

Answer 13

trauma

perforation

Question 14

What are causes of chronic endo periodontal lesions

Answer 14

pre existing periodontitis

slow and chronic progression without evident symptoms

Question 15

What are the signs and symptoms of endo-periodontal lesions

Answer 15

deep periodontal pockets reaching or close tot he 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 color alterations

Question 16

Explain how exposed dentinal tubules can lead to endo - periodontal lesions

Answer 16

in a % of the population there is a bit of dentine that is not covered by enamel nor cementum
this means dental plaque can reach exposed dentine and can cause inflammation

Question 17

How can lateral and accessory canals lead to endo - periodontal lesions

Answer 17

certain percentage have their lateral canals fairly coronal and this can result in periodontal bacteria infecting the pulp

not common

Question 18

How can furcal canals lead to endo-periodontal lesions

Answer 18

furcation of molars may also be a direct pathway of communication between pulp and periodontium

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

patent small portals of exit are a potential pathway for microorganisms and toxic by products

Question 19

What is the relevance of the apical foramen in endo-periodontal lesions

Answer 19

main route of communication between the pulp and the periodontium

microbial and inflammatory by products may exit the apical foramen causing periradicular pathoses

the apex is a portal of entry for inflammatory by-products from deep periodontal pockets to affect the pulp

Question 20

How is perforations relevant in perio-endo lesions

Answer 20

results in communication between root canal system and either peri-radicular tissues, periodontal ligament or oral cavity

Question 21

What are the causes of perforation

Answer 21

extensive dental caries
resorption
operator error e.g root canal instrumentation or post prep

Question 22

What is a developmental groove

Answer 22

invagination
vertical development radicular groove

if epithelial attachment remains intact, the periodontium remains healthy but if attachment is breached the groove becomes contaminated, a self sustaining infra bony pocket can form along its entire length

the channel provides a place for accumulation of bacterial biofilm and a route for the progression of periodontitis that may also affect the pulp if it extends to the apex. radiographically the area of bone destruction follows the course of the groove

Question 23

What was the previous classification

Answer 23

primary endodontics lesion
primary periodontal lesions
primary Endodontics lesion with secondary periodontal involvement
primary periodontal lesions with secondary Endodontics involvement
true combined lesions

Question 24

What are endo-peridontal lesions associated with trauma and iatrogenic factors

Answer 24

root/pulp chamber furcation perforation

root fracture or cracking

external root resorption

pulp necrosis draining through the periodontium

Question 25

What is the treatment of perioendo lesions

Answer 25

carry out endo tx
do not prescribe AB unless systemic involvement or spreading infection
recommend use of 0.2% chlorhexidine mouthwash
following acute management of lesion, review within 10 days and carry out RSD if necessary

Question 26

Does Endodontics diseases affect periodontal health

Answer 26

When pulp becomes infected, it elicits an inflammatory response in periodontal ligament at apical foramen and / or adjacent to openings of small portals of exit

Question 27

Is pulp significantly effected by periodontal disease

Answer 27

not significantly effected unless recession affects a lateral or accessory canal to the mouth

bacteria access through lateral or accessory canal into pulp causing chronic inflammation and possible necrosis

if 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 invasions dn secondary inflammation nd necrosis of the pulp can occur if scaling curettage or periodontal surgery accessory canals are severe and opened to the oral environment