Periodontal Abscess and Furcations

Question 1

What is an abscess?

Answer 1

A localized collection of pus in a cavity formed by disintegration of tissues

Question 2

What is formation of pus termed?

Answer 2

Suppuration

Question 3

What are the different types of abscesses?

Answer 3

Endodontic, periapical, dentoalveolar, pericoronal (pericoronitis), trauma, and foreign body

Question 4

How is a dental abscess identified clinically?

Answer 4

Through signs and symptoms such as pain, redness and swelling, regional lymph node enlargement

Question 5

What is an abscess that only involves soft tissues termed?

Answer 5

Cellulitis

Question 6

What is an abscess that involves bone termed?

Answer 6

Osteitis

Question 7

What is an abscess that involves bone marrow termed?

Answer 7

Osteomyelitis

Question 8

What do dental abscesses expand through?

Answer 8

Those tissues providing least resistance, forming a sinus tract

Question 9

What is a periodontal abscess?

Answer 9

Localized accumulation of pus located within gingival wall of periodontal pocket

Question 10

What is a periodontal abscess also known as?

Answer 10

A lateral periodontal abscess

Question 11

What is the most common cause of tooth loss during periodontal maintenance?

Answer 11

Periodontal abscess

Question 12

What is the severe systemic consequence of a periodontal abscess?

Answer 12

Ludwig’s angina

Question 13

What is the pathology of a periodontal abscess?

Answer 13

Bacterial invasion of soft tissues around periodontal pocket, inflammatory process (PMN – Cytokines – destruction of connective tissues), encapsulation of bacterial infection and production of pus

Question 14

What is drainage of a periodontal abscess most likely to take place through?

Answer 14

Periodontal pocket since this is usually path of least resistance

Question 15

What is the iatrogenic pathology of a periodontal abscess?

Answer 15

Foreign bodies such as calculus and food debris may be pushed into gingival tissue during debridement and cause abscess formation

Question 16

What are the symptoms of a peridontal abscess?

Answer 16

Pain, tenderness of gingiva, swelling ovoid elevation in gingiva along lateral part of root/tooth “elevation”, suppuration on probing/sampling was common (66– 93%) whereas a fistula was not, deep periodontal pocket (7.3– 9.3 mm), bleeding on probing (100%), increased tooth mobility (56.4– 100%), bone loss was normally seen, and extraoral findings were uncommon: facial swelling (3.6%), elevated body temperature, malaise, regional lymphadenopathy (7–40%) or increased blood leukocytes (31.6%)

Question 17

What do all studies on periodontal abscesses suffer from problem of?

Answer 17

Mixing abscess flora with that of periodontal pocket

Question 18

What are the causes of periodontal abscess in a periodontal patient?

Answer 18

Acute exacerbation and after different treatments

Question 19

When can acute exacerbation of periodontitis occur?

Answer 19

In untreated periodontitis, “refractory” periodontitis, and in periodontal maintenance

Question 20

What treatments can lead to a periodontal abscess in periodontitis patients?

Answer 20

Scaling and RSD, surgical periodontal therapy, systemic antimicrobial intake, without subgingival debridement, and use of other drugs: e.g., nifedipine

Question 21

What causes periodontal abscess in a non-periodontitis patient?

Answer 21

Foreign body impaction (floss, toothpick), habits (nail biting, wire biting), inadequate orthodontic forces, gingival enlargement, and alteration of root surface (invaginated tooth, grooves, perforations, fractures, external resorption)

Question 22

What is the differential diagnosis of periodontal abscess?

Answer 22

Other odontogenic abscesses (dento-alveolar abscesses, pericoronitis, endo-periodontal abscess)/other acute conditions (lateral periapical cyst and postoperative infection), tumour lesions, including metastatic tumoral lesions, odontogenic myxoma, non-Hodgkin ́s lymphoma, squamous cell carcinoma, metastatic carcinoma, other oral lesions: pyogenic granuloma, osteomyelitis, odontogenic keratocyst, eosinophilic granuloma, self-inflicted gingival injuries, and sickle cell anaemia

Question 23

What is the treatment of a periodontal abscess?

Answer 23

Incise abscess and create drainage, irrigation with antiseptic solutions, and after abscess resolution ,periodontal infections should continue to be treated by subgingival debridement

Question 24

When are antimicrobial agents indcated?

Answer 24

Only when patient shows signs systemic involvement (fever, malaise, lymphadenopathy)

Question 25

What is the aim of systemic antibiotic treatment of dental abscesses?

Answer 25

Preventing bacterial spreading and serious complications

Question 26

What is furcation involvement?

Answer 26

Bone loss to bi/trifurcation region of multirooted teeth

Question 27

What is furcation usually as a result of?

Answer 27

Periodontal disease

Question 28

What is the root complex?

Answer 28

CEJ to apex

Question 29

What is the root trunk?

Answer 29

CEJ to furcation

Question 30

What is the root cone?

Answer 30

Beyond the furcation

Question 31

What is grade I furcation?

Answer 31

Incipient early lesion, early bone loss, and less than 1/3 of furcation ‘width’

Question 32

What is grade II furcation?

Answer 32

More than 1/3 of furcation ‘width’ but NOT through and through

Question 33

What is grade III furcation?

Answer 33

Through and through lesion identified most accurately with a Nabers probe

Question 34

What is the non-surgical treatment of furcation defects?

Answer 34

Aim is for cleanliness (by us and by patient)

Question 35

What are the outcomes of non-surgical treatment of furcation defects?

Answer 35

Less promising

Question 36

What is the surgical treatment of furcation defects?

Answer 36

‘Furcationplasty’, tunnel preps, root resection, and GTR

Question 37

What are the indications for root resection?

Answer 37

Isolated defect around 1 root of a multi-rooted tooth, caries, failed root filling, and furcation