Perio-endo and periodontal abscesses Flashcards
What is a periodontal abscess usually associated with?
- preexisting deep pocket
- also food packing and tightening of gingival margin post hygiene phase therapy
What is a gingival abscess?
an abscess localised to the gingival margin
define ‘periodontal abscess’
Infection within a periodontal pocket which can be acute or chronic and asymptomatic if freely draining
what is a pericoronal abscess associated with?
partially erupted tooth
- most commonly 8s
Why do teeth with a periodontal abscess tend to have a poor prognosis?
as a result of rapid destruction of periodontal tissues
What are the signs and symptoms of a periodontal abscess?
- 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)
Outline how you would treat an emergency patient presenting with a periodontal abscess
- 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
What antibiotics can you prescribe to a patient with a periodontal abscess if there are signs of a systemic infection?
- Phenoxymethylpenicillin 250mgx2, 4x a day for 5 days
- Amoxycillin 500mg, 3 times daily for 5 days
- Metronidazole 400mg, 3 times daily for 5 days
If you were to prescribe a patient presenting with a periodontal abscess antibiotics, what must you also do?
-mechanical therapy should also be used
- to disrupt biofilm
- and reduce bacterial load
What is an Endo-periodontal lesion?
a pathological communication between the Endodontic and periodontal tissues of a given tooth
tooth is suffering from varying degrees of endodontic and periodontal disease
What are the acute causes of an Endo-periodontal lesion?
- trauma
- perforation
what are the chronic causes of an Endo-periodontal lesion?
- pre-existing periodontitis
- slow and chronic progression without symptoms
Outline the signs and symptoms of an Endo-periodontal lesion
- deep periodontal pockets reaching 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
Outline the possible routes of communication between the pulp and periodontium
- exposed dentinal tubules
- lateral and accessory canals
- furcal canals
- apical foramen
What is the main route of communication between the pulp and periodontium?
- the apical foramen
perforation - potential causes
extensive dental caries
resorption
operator error
- e.g. root canal instrumentation or post preparation
What does perforation lead to?
communication between the root canal system and either peri-radicular tissues, periodontal ligament or the oral cavity
Why can infection arise from the apical foramen?
- 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
outline how you would treat a patient presenting with a Perio-endo lesion
- 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
examples of endo-periodontal lesions with root damage
root fracture or cracking
root canal or pulp chamber perforation
external root resorption
examples of endo-periodontal lesions without root damage
endo-periodontal lesion in peridodontitis patients
endo-periordontal lesion in non-periodonitis patients
endo-periodntal lesions without root damage: give the classifications/grades
grade 1
- narrow deep periodontal pocket in 1 tooth surface
grade 2
- wide deep periodontal pocket in 1 tooth surface
grade 3
- deep periodontal pockets in more than 1 tooth surface
