Perio/Endo Lesions and Abscesses

Question 1

what is a gingival abscess

Answer 1

abscess localised to gingival margin

Question 2

what is a periodontal abscess

Answer 2

related to preexisting deep pocket also associated with food packing and tighenting of gingival margin

Question 3

what is a pericoronal abscess

Answer 3

associated with partially erupted tooth (commonly 8s)

Question 4

what is an endodontic periodontal lesion

Answer 4

tooth suffering from varying degrees of endodontic and periodontal disease

Question 5

what occurs during a periodontal abscess

Answer 5

rapid destruction of the periodontal tissues with a negative effect on prognosis of affected teeth

Question 6

what are the signs and symptoms of a periodontal abscess

Answer 6

swelling
pain
tooth TTP in lateral direction
deep periodontal pocket
bleeding
suppuration
enlarged regional lymph nodes
fever
tooth usually vital
pre-existing periodontal disease

Question 7

what are the SDCEP guidelines for treating a periodontal abscess

Answer 7

careful subgingival instrumentation short of base of pocket
incise and drain or drain through pocket
recommend analgesia
no antibiotics - unless systemic
use 0.2% chlorhexidine mouthwash
review and carry out periodontal instrumentation

Question 8

when would you prescribe antibiotics for periodontal abscesses

Answer 8

only if signs of spread and systemic effects or if symptoms do not resolve with local measures

Question 9

what antibiotics would be prescribed for an abscess

Answer 9

pen V 250mg - 5 days
amoxicillin 500mg - 5 days

Question 10

what must antibiotics be used in conjunction with when treating periodontal abscesses

Answer 10

mechanical therapy in order to reduce bacterial load and disrupt biofilm

Question 11

what are the ways that infection can spread to periapical tissues

Answer 11

via carious cavity or traumatised crown
via periodontal ligament

Question 12

what would cause an acute abscess

Answer 12

trauma or perforation

Question 13

what would cause a chronic abscess

Answer 13

pre-existing periodontitis

Question 14

what are the signs and symptoms of a perio endo lesion

Answer 14

deep perio pockets reaching or close to apex
negative response to vitality test
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 15

what are the paths of communication between pulp and periodontium

Answer 15

exposed dentinal tubules
lateral canals
furcal canals
pulpal inflammation causing patent portals of exit
APICAL FORAMEN
perforation
developmental groove

Question 16

what is the main route of communication between pulp and periodontium

Answer 16

apical foramen

Question 17

what are the causes of perforation

Answer 17

extensive dental caries
resorption
operator error

Question 18

how do you classify perio endo lesions

Answer 18

carious lesion which affects pulp and secondarily periodontium
periodontal destruction that secondarily affects root canal
both events at same time

Question 19

what are the types of trauma which can result in a perio endo lesion

Answer 19

root/pulp chamber furcation perforation
root fracture or cracking
external root resorption
pulp necrosis draining through periodontium

Question 20

what are the SDCEP guidelines for treating a perio endo lesion

Answer 20

carry out endo treatment
recommend optimal analgesia
do not prescribe antibiotics
chlorhexidine mouthwash
review within 10 days for PMPR if necessary

Question 21

what types of treatment are available for perio endo lesions

Answer 21

primary endodontic therapy
periodontal therapy
surgical investigation and treatment

Question 22

does endodontic disease affect periodontal health

Answer 22

when pulp is infected it elicits inflammatory response in PDL at apical foramen so yes it does

Question 23

does periodontal disease affect endodontic health

Answer 23

not until recession affects a lateral/accessory canal which bacteria can invade