Perio-Endo and Periodontal Abscess Flashcards
What are the different types of periodontium abscesses
gingival abscess
periodontal abscess
pericoronal abscess
Endodontics periodontal lesion
What is gingival abscess
localized to gingival margin
What are the most common causes of gingival abscesses
trauma
food impaction
recent surgery
can result in localized infection in gingiva but is not associated with periodontal disease
What are periodontal abscess usually related to
usually related to pre-existing deep pocket also associated with food packing and tightening gingival margin post HPT
What are pericoronal abscess associated with
associated with partially erupted tooth, most commonly 8s
What are Endodontics periodontal lesions
tooth is suffering from varying degree of Endodontics and periodontal disease
What is a periodontal abscess
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
What are signs and symptoms of periodontal 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 does SDCEP guidelines say about tx of periodontal abscess
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
When can we prescribe AB for periodontal abscess
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
What AB do we prescribe for periodontal abscess
amoxycillin 500mg 5 days TID
OR
metronidazole 400mg 5 days TID
What are endo-periodontal lesions
pathological communication between Endodontics and periodontal tissue of a given tooth
What are causes of acute endo periodontal lesions
trauma
perforation
What are causes of chronic endo periodontal lesions
pre existing periodontitis
slow and chronic progression without evident symptoms
What are the signs and symptoms of endo-periodontal lesions
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
Explain how exposed dentinal tubules can lead to endo - periodontal lesions
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
How can lateral and accessory canals lead to endo - periodontal lesions
certain percentage have their lateral canals fairly coronal and this can result in periodontal bacteria infecting the pulp
not common
How can furcal canals lead to endo-periodontal lesions
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
What is the relevance of the apical foramen in endo-periodontal lesions
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
How is perforations relevant in perio-endo lesions
results in communication between root canal system and either peri-radicular tissues, periodontal ligament or oral cavity
What are the causes of perforation
extensive dental caries
resorption
operator error e.g root canal instrumentation or post prep
What is a developmental groove
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
What was the previous classification
primary endodontics lesion
primary periodontal lesions
primary Endodontics lesion with secondary periodontal involvement
primary periodontal lesions with secondary Endodontics involvement
true combined lesions
What are endo-peridontal lesions associated with trauma and iatrogenic factors
root/pulp chamber furcation perforation
root fracture or cracking
external root resorption
pulp necrosis draining through the periodontium
What is the treatment of perioendo lesions
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
Does Endodontics diseases affect periodontal health
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
Is pulp significantly effected by periodontal disease
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
