Periodontal Abscess Flashcards
What percentage of periodontitis patients have been seen to have LPA?
28%
60% if untrested
if repated hopelss prognosis
45% of teeth with abscess on maintence pahse is extacted
Give 5 systemic features of LPA.
- normal oral epithelium and lamina propria
- inflammatory cell infiltrate
- mass of granular, acidophilic and amorphous debris
- intense foci of neutrophil and lymphocyte accumulation around necrotic connective tissue
- ulcerated pocket epitheilum
Give 4 common signs of LPA.
- swollen gingiva
- pus discharge through the sinus/buccal or linual attached gingiva or pocket
- tooth may be slighly tender to percussion
- tooth may be mobile
Give 2 rare signs of LPA.
cellulitis or lymphadenopathy
Give 2 common patient complaints if they have LPA.
- pain and discomfort
variable serverity, the pain deep throbbing pain and slight discomfort depending on drainage and painful on biting
swollen gum
Give 2 rare patient complaints if they have LPA.
facial swelling and swollen glands
Give 3 conditions that have similar signs/symptoms to LPA.
lateral periapical cysts
vertical root fracture
endoperio lesion
How can you differentially diagnose LPA?
- history of periodontitis
- previous periodontal therapy
- deep pockets/ suppuration when probed
- tooth is vital
Give a systemic host response reason to why LPA can arise.
impaired host response
- diabetes - suspect if multiple abscesses
- drugs that are promiting ginigival enlargement ca channel blockers
Give 5 local predisposing factors to LPA.
- Pre-existing periodontitis:
-Obstruction of the opening of a deep pocket eg. furcation
-Impaction of plaque & calculus following scaling (Rarely)
-Gingival cuff tightens after treatment
- Impaction of a foreign body into pocket or tissues eg floss, elastic, impression material, toothpick, food debris
- Use of systemic antimicrobials, for dental or nondental reasons, without instrumentation
- Iatrogenic foreign body – suture / membrane / graft
- Unusual tooth / root anatomy:
-Developmental grooves / enamel pearls / invaginations
-Restorations impeding access for OH (furcations / proximal)
-Root cracks or fractures
-External root resorption
-Root perforations
What bacteria are commonly found in LPAs?
–Porphyromonas gingivalis (50-100%),
–Prevotella intermedia,
–Prevotella melaninogenica,
–Fusobacterium nucleatum,
–Tannerella forsythia,
–Treponema species,
–Campylobacter species,
–Peptostreptococcus micros and species
What history is taken for a patient with potential LPA.
Careful attention to predisposing medical history
History of dental trauma & previous dental treatment
Careful pain history
When carrying out an intra-oral examination for a patient with potential LPA what must you look out for?
Attention to other periodontal disease
Caries, heavily restored or cracked teeth
What special investigations would you carry out for a patient with potential LPA?
–Vitality tests and radiographs
–Insertion of GP point into sinus & abscess
The GP point will go to the abscess rather than the apex of the tooth if it is a perio problem
What is the initial treatment for LPA?
Establish drainage if possible - Subgingival scaling if comfort permits
Course of antimicrobials
Metronidazole 400mg tds 5 days or
Amoxicillin 500mg tds 5 days or–Azithromycin 500mg 3 days
Review
Endodontic lesions - initiate RCT
How is LPA managed long-term?
Consider extraction if prognosis poor
Prevent recurrence by treating periodontal disease– May consider surgery subject to response to initial therapy
If the lesion is a perio-endo lesion what must be treated first and why?
Treat the primary endodontic component first–scaling may destroy cells able to repair ligament
