Periodontal Abscess and Furcations Flashcards
What is an abscess?
A localized collection of pus in a cavity formed by disintegration of tissues
What is formation of pus termed?
Suppuration
What are the different types of abscesses?
Endodontic, periapical, dentoalveolar, pericoronal (pericoronitis), trauma, and foreign body
How is a dental abscess identified clinically?
Through signs and symptoms such as pain, redness and swelling, regional lymph node enlargement
What is an abscess that only involves soft tissues termed?
Cellulitis
What is an abscess that involves bone termed?
Osteitis
What is an abscess that involves bone marrow termed?
Osteomyelitis
What do dental abscesses expand through?
Those tissues providing least resistance, forming a sinus tract
What is a periodontal abscess?
Localized accumulation of pus located within gingival wall of periodontal pocket
What is a periodontal abscess also known as?
A lateral periodontal abscess
What is the most common cause of tooth loss during periodontal maintenance?
Periodontal abscess
What is the severe systemic consequence of a periodontal abscess?
Ludwig’s angina
What is the pathology of a periodontal abscess?
Bacterial invasion of soft tissues around periodontal pocket, inflammatory process (PMN – Cytokines – destruction of connective tissues), encapsulation of bacterial infection and production of pus
What is drainage of a periodontal abscess most likely to take place through?
Periodontal pocket since this is usually path of least resistance
What is the iatrogenic pathology of a periodontal abscess?
Foreign bodies such as calculus and food debris may be pushed into gingival tissue during debridement and cause abscess formation
What are the symptoms of a peridontal abscess?
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%)
What do all studies on periodontal abscesses suffer from problem of?
Mixing abscess flora with that of periodontal pocket
What are the causes of periodontal abscess in a periodontal patient?
Acute exacerbation and after different treatments
When can acute exacerbation of periodontitis occur?
In untreated periodontitis, “refractory” periodontitis, and in periodontal maintenance
What treatments can lead to a periodontal abscess in periodontitis patients?
Scaling and RSD, surgical periodontal therapy, systemic antimicrobial intake, without subgingival debridement, and use of other drugs: e.g., nifedipine
What causes periodontal abscess in a non-periodontitis patient?
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)
What is the differential diagnosis of periodontal abscess?
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
What is the treatment of a periodontal abscess?
Incise abscess and create drainage, irrigation with antiseptic solutions, and after abscess resolution ,periodontal infections should continue to be treated by subgingival debridement
When are antimicrobial agents indcated?
Only when patient shows signs systemic involvement (fever, malaise, lymphadenopathy)
What is the aim of systemic antibiotic treatment of dental abscesses?
Preventing bacterial spreading and serious complications
What is furcation involvement?
Bone loss to bi/trifurcation region of multirooted teeth
What is furcation usually as a result of?
Periodontal disease
What is the root complex?
CEJ to apex
What is the root trunk?
CEJ to furcation
What is the root cone?
Beyond the furcation
What is grade I furcation?
Incipient early lesion, early bone loss, and less than 1/3 of furcation ‘width’
What is grade II furcation?
More than 1/3 of furcation ‘width’ but NOT through and through
What is grade III furcation?
Through and through lesion identified most accurately with a Nabers probe
What is the non-surgical treatment of furcation defects?
Aim is for cleanliness (by us and by patient)
What are the outcomes of non-surgical treatment of furcation defects?
Less promising
What is the surgical treatment of furcation defects?
‘Furcationplasty’, tunnel preps, root resection, and GTR
What are the indications for root resection?
Isolated defect around 1 root of a multi-rooted tooth, caries, failed root filling, and furcation
