Perio-Endo & Periodontal Abscess

Question 1

What are the features of a gingival abscess?

Answer 1

• localised to gingival margin
• no bone loss associated
• commonly caused by local trauma/food packing/interproximal cleaning

Question 2

What are the features of a periodontal abscess?

Answer 2

• usually related to pre-existing periodontal deep pocket
• associated with food packing
• associated of gingival margin post PMPR

Question 3

What are the features of a pericoronal abscess?

Answer 3

• associated with partially erupted tooth
• most commonly 8s

Question 4

What are the features of a endodontic-periodontics lesion?

Answer 4

• tooth is suffering from varying degrees of endodontic and perio disease

Question 5

What is the SDCEP definition of a periodontal abscess?

Answer 5

Infection in a periodontal pocket which can be acute or chronic and asymptomatic if freely draining

Question 6

What do periodontal abscesses cause?

Answer 6

Rapid destruction of periodontal tissues (bone dissolving), with a negative effect on the prognosis of the affect tooth

Question 7

What are the signs and symptoms of a periodontal abscess?

Answer 7

• swelling
• pain
• tooth may be TTP in lateral direction
• deep perio pocket
• bleeding
• suppuration
• enlarged regional lymph nodes
• fever

Question 8

How are periodontal abscesses treated according to SDCEP guidelines?

Answer 8

• carry out sub gingival instrumentation short of the base of the perio pocket
• drain pus if present, by incision or through perio pocket
• recommend analgesia
• only prescribe antibiotics if there are signs of spreading systemic infection
• recommend use of chlorohexidine mouthwash

Question 9

During treatment of periodontal abscesses, why is it important that sub-gingival instrumentation is important?

Answer 9

to avoid iatrogenic damage to the already weak tissues

Question 10

What strength of chlorohexidine mouthwash should be prescribed?

Answer 10

0.2%

Question 11

IF systemic antibiotics are required, what would be prescribed?

Answer 11

• penicillin V 250mg (5days)
• amoxicillin 500mg (5days)
• metronidazole 400mg (5days)

Question 12

what is an endo-periodontal lesion?

Answer 12

A pathological communication between the endodontic and periodontal tissues of a given tooth

Question 13

What could cause an acute perio-endo lesion?

Answer 13

• trauma
• perforation

Question 14

What could cause a chronic perio-endo lesion?

Answer 14

• pre-existing periodontitis
• slow and chronic progression without evident symptoms

Question 15

what are some signs & symptoms of perio-endo lesions?

Answer 15

• 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 or palpation & percussion
• purulent exudate
• tooth mobility
• sinus tract
• crown & gingival

Question 16

What is the most common sign of a perio-endo lesion?

Answer 16

Swelling up around the apex of the tooth

Question 17

What percentage of all teeth have lateral & accessory canals?

Answer 17

30-40%

Question 18

What is the main route of communication between the pulp & the periodontium?

Answer 18

The apical foramen

Question 19

Why can communication between the pulp and periodontium be problematic?

Answer 19

• microbial and inflammatory byproducts may exit the apical foramen causing peri-radicular pathoses
• the apex is a portal of entry for inflammatory byproducts from deep periodontal pockets to affect the pulp

Question 20

What does perforation cause?

Answer 20

Results in communication between the root canal system and either peri-radicular tissues, periodontal ligament or the oral cavity

Question 21

What can cause perforation?

Answer 21

• extensive dental caries
• resorption
• operator error during root canal instrumentation etc

Question 22

Why might endo-periodontal lesions associated with trauma/iatrogenic factors occur?

Answer 22

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

Question 23

How are perio-endo lesions treated according to the SDCEP guidelines?

Answer 23

• carry out endo treatment of affected tooth
• recommend analgesia
• ONLY prescribe antibiotics if signs of spreading/systemic infection
• recommend use of 0.2% Chlorohexidine mouthwash to aid acute symptoms
• review within 10 days & carry our supra/subgingival scaling if necessary

Question 24

Does endodontic disease affect periodontal health?

Answer 24

When the pulp becomes infected, it elicits an inflammatory response in the periodontal ligament at the apical foramen and/or adjacent to openings of the small portals of exit