Periodontal Emergencies

Question 1

What is a periodontal abscess?

Answer 1

Localised accumulation of pus within the gingival wall of a periodontal pocket resulting in the destruction of the collagen fibre attachment and the loss of nearby alveolar bone

Question 2

What is the presentation of a periodontal abscess?

Answer 2

Red, swollen area
Tender to touch
Bleeding
Tender to Percussion
Suppuration
Tooth feeling high
At the attached gingiva/mucosa

Question 3

What is the treatment of a periodontal abscess?

Answer 3

Debridement of pocket
Establish drainage
Re-evaluate perio treatment

Question 4

What is the sensibility testing on a tooth with a periodontal abscess?

Answer 4

Positive

Question 5

What is a gingival abscess?

Answer 5

Localised perulent infection that involves the marginal gingiva of interdental papilla

Question 6

What is the presentation of a gingival abscess?

Answer 6

Rapidly expanding localised area or swelling that may be shiny, smooth or pointed
Suppuration may be present
Usually painful
TTP
At the marginal gingiva/interdental papilla

Question 7

What is the aetiology of a gingival abscess?

Answer 7

Subginigvally impacted foreign objects
can be calculus/food/parafunctional habit (i.e. nail biting)

Question 8

What is the treatment of a gingival abscess?

Answer 8

Incised, drained and irrigated with saline

Question 9

What would the sensibility results be in a tooth that has a gingival abscess?

Answer 9

Positive

Question 10

What is a perio-endo lesion?

Answer 10

Combined periodontal/endodontic lesion are localised, circumscribed areas of infection originating in the periodontal and/or pulpal tissues

Question 11

What is the presentation of a perio-endo lesion?

Answer 11

Non vital tooth
Mobile
TTP

Question 12

What is the presentation of Acute Necrotising Ulcerative Gingivitis (ANUG)?

Answer 12

Most common in mandibular anterior teeth
Necrosis & ulcers in free gingiva
Start at the interdental papilla
Punched out appearance
Erythematous
Pseudo-membranous can form
–when this is removed underlying connective tissue bleeds

Question 13

What are the associated symptoms with ANUG?

Answer 13

Halitosis
Fever
Malaise

Question 14

What is the difference between Necrotising Gingivitis and Periodontitis?

Answer 14

In periodontitis, necrosis also affects the PDL and alveolar bone leading to attachment loss

Question 15

What are the risk factors for Necrotising Gingivitis?

Answer 15

Poor nutrition
High stress levels
Heavy smoking
Immunosuppressed patients

Question 16

What is the management of necrotising periodontal diseases?

Answer 16

Surgical debridement
-to remove soft and mineralised deposits
-use ultrasonic as there is less pressure on the ulcerated soft tissues
-performed daily, getting deeper as patient tolerance improves
Chlorhexidine mouthwash
Hydrogen peroxide mouthwash
Systemic antimicrobials
–metronidazole, 400mg 3x daily for 5 days

Question 17

What is the presentation of acute herpetic gingivostomatitis?

Answer 17

Small ulcers with elevated margins on both attached and unattached mucosal surfaces
Generalised pain in gingiva/oral mucosa
Systemic signs
–lymphadenopathy
–fever
–malaise
Lesions last 7-10 days and heal without scarring
Most common in children

Question 18

What is acute herpetic gingivostomatitis caused by?

Answer 18

Herpes simplex virus (HSV-1)

Question 19

What is the emergency management of acute herpetic gingivostomatitis?

Answer 19

Hydration
Pain relief
Acyclovir