Perio-endo and periodontal abscesses

Question 1

What is a periodontal abscess usually associated with?

Answer 1

• preexisting deep pocket
• also food packing and tightening of gingival margin post hygiene phase therapy

Question 2

define ‘periodontal abscess’

Answer 2

Infection within a periodontal pocket which can be acute or chronic and asymptomatic if freely draining

Question 3

Why do teeth with a periodontal abscess tend to have a poor prognosis?

Answer 3

as a result of rapid destruction of periodontal tissues

Question 4

What are the signs and symptoms of a periodontal abscess?

Answer 4

• swelling
• pain
• tooth may be TTP in lateral direction
• deep periodontal pocket
• bleeding
• enlarged regional lymph nodes
• fever
• tooth usually vital
• commonly pre-existing periodontal disease
• suppuration (discharge of pus)

Question 5

Outline how you would treat an emergency patient presenting with a periodontal abscess

Answer 5

• Carry out careful sub-gingival instrumentation short of the base of the periodontal pocket to avoid iatrogenic damage (LA may be required)
• if pus present - drain by incision or through periodontal pocket
• recommend optimal analgesia
• do not prescribe antibiotics unless signs of spreading infection or systemic involvement
• recommend use of 0.2% chlorohexidine mouthwash until acute symptoms subside
• follow acute management, review and carry out definitive periodontal instrumentation and arrange an appropriate recall interval

Question 6

What antibiotics can you prescribe to a patient with a periodontal abscess if there are signs of a systemic infection?

Answer 6

• Penicillin V 250mg for 5 days
• Amoxycillin 500mg for 5 days
• Metronidazole 400mg for 5 days

Question 7

If you were to prescribe a patient presenting with a periodontal abscess antibiotics, what must you also do?

Answer 7

-mechanical therapy should also be used
- to disrupt biofilm
- and reduce bacterial load

Question 8

What is an Endo-periodontal lesion?

Answer 8

a pathological communication between the Endodontic and periodontal tissues of a given tooth

Question 9

What are the acute causes of an Endo-periodontal lesion?

Answer 9

• trauma
• perforation

Question 10

what are the chronic causes of an Endo-periodontal lesion?

Answer 10

• pre-existing periodontitis
• slow and chronic progression without symptoms

Question 11

Outline the signs and symptoms of an Endo-periodontal lesion

Answer 11

• deep periodontal pockets ruching 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 or percussion
• tooth mobility
• crown and gingival colour alterations
  -sinus tract
• purulent exudate

Question 12

Outline the possible routes of communication between the pulp and periodontium

Answer 12

• exposed dentinal tubules
• lateral and accessory canals
• furcal canals
• apical foramen

Question 13

What is the main route of communication between the pulp and periodontium?

Answer 13

• the apical foramen

Question 14

What does perforation lead to?

Answer 14

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

Question 15

Why can infection arise from the apical foramen?

Answer 15

• microbial and inflammatory by-products may exit the apical foramen causing peri-radicular infection
• apex is a portal of entry for inflammatory by-products from deep periodontal tissues to affect the pulp

Question 16

outline how you would treat a patient presenting with a Perio-endo lesion

Answer 16

• carry out Endodontic treatment on affected tooth
• recommend optimal analgesia
• do not prescribe antibiotics unless signs of spreading infection or systemic involvement
• recommend 0.2% chlorohexididne mouthwash until symptoms subside
• review within 10 days and carry out supra and sub gingival instrumentation if necessary
• arrange appropriate recall interval