Perio-Endo Lesions and Periodontal Abscess Flashcards
What are the different types of abscesses of the periodontium?
Gingival abscess - localised to gingival margin
Periodontal abscess - usually related to pre-existing deep pocket
Perio coronal abscess - associated with partially erupted tooth most commonly 8s
Endodontic-periodontal lesion - tooth is suffering from varying degrees of endodontic and periodontal disease
What is a periodontal abscess?
Infection in a periodontal pocket which may be symptomatic or asymptomatic if freely draining
Causes rapid destruction of periodontal tissues with a negative affect on the prognosis of the tooth
What are the signs and symptoms of an abscess?
Swelling
Pain
Tooth TTP in a lateral direction
Deep periodontal pocket
Bleeding
Suppuration
Enlarged regional LNs
Fever
Tooth usually vital
Pre-existing periodontal disease
What are the SDCEP guidelines on treatment of an abscess?
Carry out subgingival instrumentation short of the base of the pocket, LA may be required
Is pus is present, drain by incision or through the pocket
Recommend optimal analgesia
Do not prescribe antibiotics unless signs of spreading infection or systemic involvement
Recommend use of 0.2% chlorhexidine mouthwash until the acute symptoms subside
Review and carry out definitive instrumentation and arrange a recall appointment
When and how should systemic antibiotics be prescribed for an abscess?
Only if signs of spreading or systemic effects
Penicillin V 250mg 2 tablets 4 times daily for 5 days or amoxicillin 500mg TTD 5 days
Or metronidazole 200mg TTD 5 days
What is an endo-periodontal lesion?
EPL - a pathological communication between the endodontic and periodontal tissues of a tooth
What are the signs and symptoms of EPLs?
Deep periodontal pocket reaching or closed to the apex
Negative or altered response to pulp vitality tests
Bone resorption in the apical or furcation region
Spontaneous pain
Pain on palpation and percussion
Purulent exudate
Tooth mobility
Sinus tract
Crown and gingival colour changes
How can exposed dentinal tubules lead to an EPL?
interaction of soluble material from plaque bacteria to exposed dentine can cause pulpal inflammation
This exposure is common ad the CEJ
What percentage of lateral and accessory canals are associated with the involvement of a periodontal pocket?
2%
What are furcal canals?
The furcation of molars can be a direct pathway of communication between the pulp and the periodontium
What are apical foramen and how can they contribute to EPLs?
The main route of communication between the pulp and the periodontium
Microbial and inflammatory by-products may exit this causing periradicular pathology
The apex is a portal of entry for inflammatory by-products from deep periodontal pockets to affect the pulp
What is perforation?
Result of the communication between the root-canal system and either peri-radicular tissues, PDL or the oral cavity
What are the causes of perforation?
Extensive dental caries
Resorption
Operator error
What is a developmental groove?
A vertical developmental radicular groove found especially in upper incisors
If attachment is lost, the groove becomes contaminated and a pocket can form along its length
The channel provides a place of plaque accumulation and a route for the progression of periodontitis to affect the pulp
How are EPLs classed?
By a carious lesion that affects the pulp and secondarily, affects the periodontium
By periodontal destruction that secondarily affects the root canal
Or by both events occurring at the same time
