Perio-endo Lesions

Question 1

What are periodontal abscesses related to?

Answer 1

Pre-existing deep pockets. Also associated with food packing and tightening of the gingival margin

Question 2

What teeth are affected by pericoronal abscesses?

Answer 2

P/E teeth

Most commonly 8’s

Question 3

What are the signs and symptoms of a periodontal abscess?

Answer 3

Swelling 
Pain 
TTP and percussion 
Deep pocket 
Bleeding 
Suppuration 
Enlargement of the lymph nodes 
Fever 
Tooth usually vital 
Commonly pre-existing perio disease

Question 4

How would you Tx an acute periodontal abscess?

Answer 4

Relief of acute symptoms by careful subgingival debridement (not to the base of the pocket to avoid damage). This will require LA.
Drain abscess with incision if puss.
Max analgesia
A.B only if systemic
0.2% chlorhexidine until acute symptoms subside.
Set up review and carry out definitive periodontal Tx and appropriate recall interval

Question 5

What AB is prescribed for systemic involvement of periodontal abscess?

Answer 5

Penicillin 250mg or amoxicilllin 500mg for 5 days
Metronidazole (allergy) 400mg for 5 days.
This must be done with mechanical debridement

Question 6

What are the signs and symptoms of EPL?

Answer 6

Deep pockets extending too or close to the apex 
Negative or altered vitality test 
Bone resorption in apical or furcation region 
Spontaneous pain 
TTP and percussion 
Purulent exudate 
Tooth mobility 
Sinus tract 
Crown and gingival colour alterations

Question 7

What are some possible other sources of bacteria ingress to the pulp apart from the apex?

Answer 7

Exposed lateral canals without cementum protecting them. Present in furcations also.
Perforations due to deep caries, instrumentation and resorption.

Question 8

What are 3 questions you could ask yourself in order to calcify the type of EPL?

Answer 8

Is there root damage or not?
Does the patient have a perio?
How many sites are affected by the pocket and is it narrow or wide? (grade 1-3)

Question 9

What are some possible types of root damage?

Answer 9

Root # (trauma)
Perforation (instrumentation error or trauma)
Root resorption (due to trauma)

Question 10

Tx for EPL?

Answer 10

Carry out endo
Max analgesia
A.B only if systemic
0.2% chlorhexidine until acute symptoms subside.
Set up review in 10 days and carry out definitive periodontal Tx and appropriate recall interval