Perio-Endo Lesions

Question 1

What are some different abscesses of the periodontium?

Answer 1

• Gingival abscess- Periodontal abscess- Pericoronal abscess- Endodontic-periodontal lesion

Question 2

What is a gingival abscess?

Answer 2

• Infection and inflammation pocket localised to gingival margin

Question 3

What is periodontal abscess?

Answer 3

• Infection and inflammation periodontal pocket that can be acute or chronic and symptomatic if freely draining- Usually related to preexsiting deep pocket / food packing / tightening of gingival margin post HPTnd- Rapid destruction of periodontal tissues- Negative effect on prognosis of affected tooth

Question 4

What is pericoronal abscess?

Answer 4

• Infection and inflammation of tissue surrounding third molar

Question 5

What is an endodontic-periodontal lesion?

Answer 5

-Pathological communication between endodontic and periodontal tissues of a given tooth

Question 6

Signs and symptoms of periodontal abscess?

Answer 6

• Swelling- Pain- Tooth may be TTP in lateral direction- Deep periodontal pocket- Bleeding- Suppuration- Enlarged regional lymphnodes- Fever- Tooth usually vital- Pre-exisiting periodontal disease

Question 7

What is the SDCEP guidance for txt of periodontal abscess?

Answer 7

• Sub-gingival instrumentation short of base or periodontal pocket to avoid iatrogenic damage- Use LA- If pus drain by incision or through periodontal pocket- Recommend analgesia- Don’t prescribe antibiotics unless signs of spreading infection or systemic involvement- Recommend use of 0.2% chlorhexidine mouthwash until acute symptoms subside- Following acute management, review, carry out definitive periodontal instrumentation and arrange recall

Question 8

What antibiotics can be prescribed for periodontal abscess?

Answer 8

• Only prescribe is evidence of systemic involvement or spreading infection- Penicillin V 250mg or Amoxicillin 500mg 5 days- Metronidazole 400mg 5 days (if allergy to Pen V)

Question 9

What are the different types of endo-periodontal lesions?

Answer 9

Acute - Trauma - PerforationChronic - Pre-existing perio- Slow and chronic progression without evident symptoms

Question 10

What are the signs and symptoms of endo-periodontal lesions?

Answer 10

• Deep periodontal pockets reaching or close to apex- Negative or altered response to pulp vitality tests- Bone resorption in apical or furcation region- Spontaneous pain- Pain on palpation and percussion- Purulent exudate- Tooth mobility- Sinus tract- Crown and gingival colour alterations

Question 11

Can exposed dentinal tubules cause pulpal inflammation?

Answer 11

• Studies found exposure of dentin at CEJ occurs in 18-25% teeth - If containing bacterial plaque

Question 12

What are lateral or accessory canals?

Answer 12

• A channel leading from root pulp laterally through the dentin into periodontal tissue- Can be found anywhere in root but most common in apical third

Question 13

What is the percentage of teeth that have lateral or accessory canals?

Answer 13

• 30-40%

Question 14

How can lateral canals lead top pulpal inflammation?

Answer 14

• Exposed canal due to bone resorption and bacteria can get into pulp- Can get in through the periodontal space if bacteria and infection has occurred here

Question 15

How can furcal canals lead to pulpal inflammation?

Answer 15

• Furcation of molars direct pathway of communication between pulp and periodontium- Microorganisms and toxic by products

Question 16

What is the main route of communication between pulp and periodontium and what can this cause?

Answer 16

• Through apical foramen- Microbial and inflammatory by-products may exit apical foramen causing periradicular pathoses- Apex if portal of entry for inflammatory by products from deep periodontal pockets to affect the pulp

Question 17

What does perforation lead to?

Answer 17

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

Question 18

What are the causes of perforation?

Answer 18

• Extensive dental caries- Resorption- Operator error e.g. root canal instrumentation or post preparation

Question 19

What is a developmental groove?

Answer 19

• Invagination (cavity formed by being turned inside out or folded back)- Vertical developmental radicular groove- Especially upper incisors

Question 20

How can a developmental groove lead to periodontitis?

Answer 20

• Epithelial attachment breached- Groove becomes contamiinated- Self sustaining infrabony pocket forms- Pocket accumulates bacterial biofilm- Microorganisms travel down and can infect periodontium and can progress into pulp

Question 21

What is the SDCEP treatment of perio-endo lesions?

Answer 21

• Endodontic treatment on affected tooth- Recommend optimal analgesia- Don’t prescribe antibiotics unless signs of spreading infection or systemic involvement- Recommend 0.2% chlorhexidine mouthwash until acute symptoms subside- Review within 10 days and carry out supra- and sub-gingival instrumentation if needed- Arrange recall

Question 22

In what instance is the pulp affected by periodontal disease?

Answer 22

• Only affected when recession affects lateral or accessory canal- Bacteria through lateral or accessory canal into pulp cause chronic inflammation and possibly pulp necrosis

Question 23

What are some causes of endo-periodontal lesions with root damage?

Answer 23

• Root fracture or cracking- Root canal or pulp chamber perforation- External root resorption

Question 24

What are the grades of endo-periodontal lesions without root damage?

Answer 24

Grade 1 - Narrow deep periodontal pocket in 1 tooth surfaceGrade 2 - Wide deep periodontal pocket in 1 tooth surface Grade 3 - Deep periodontal pockets in more than 1 tooth surface