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BDS4 CDS Perio > Periodontal Emergencies > Flashcards

Periodontal Emergencies Flashcards

1
Q

Describe ANUG.

A

Impaired immune response to opportunistic microbial bacteria within the gingival sulcus which causes rapid destruction of gingival and periodontal tissues.

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2
Q

What bacteria is associated with ANUG ?

A

Gram negative fusiform. spirochetes.

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3
Q

What are some key risk factors for ANUG ?

A

Smokers.
Poor OH and pre-existing marginal gingivitis.
Nutritional deficiency - Vit B and C, protein.
Immunosuppressant medications.
Immunocompromised patients - HIV, AIDS, anaemia, leukaemia.
Younger patients.
Lack of sleep and stress.
Low socioeconomic factors.

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4
Q

What are the key signs or symptoms of ANUG ?

A

Swelling.
Pain.
Spontaneous bleeding of marginal gingivae.
Halitosis (metallic taste).
Punched out appearance to papillae.
Ulceration with yellow sloughing.
Malaise, fever, lymphadenopathy.
Loss of attachment.

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5
Q

Describe the histopathological characteristics of ANUG.

A

Ulceration of stratified squamous epithelium.
Fibrinous pseudomembrane.

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6
Q

What special investigations can be used for ANUG ?

A

Full mouth PAs or OPT.
Blood tests - FBC, haematinics.

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7
Q

What are the risks of NOT treating ANUG ?

A

Aesthetics (loss of papillae).
Loss of attachment (tooth mobility, tooth loss).
Systemic infection and sepsis.

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8
Q

How should a patient with ANUG be managed ?

A
  1. Supragingival scaling with LA daily for 1-4 days.
  2. Prescribe 0.2% CHx or 6% hydrogen peroxide.
  3. Encourage gentle OH with soft bristle brush.
  4. Analgesia advice - ibuprofen, paracetamol.
  5. Encourage hydration.
  6. Systemic signs - prescribe metronidazole.
  7. Review for 10 days.
  8. Risk factor management and OHI.
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9
Q

What antibiotic prescription would you write for a patient with ANUG with systemic signs ?

A

Metronidazole 400mg 3x daily for 5 days.

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10
Q

What is the main contraindication for metronidazole ?

A

Warfarin users or allergy.

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11
Q

What instructions should you give a patient when prescribing chlorhexidine mouthrinse ?

A

0.2% chlorhexidine mouth rinse.
Use 2-3x daily.
After mealtimes and not at the same time as brushing - toothpaste will affect efficacy of mouthrinse.
Can be stingy - dilute 50:50 with water and gradually increase to full strength.
Hold in mouth for 5 mins.

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12
Q

Describe primary herpetic gingivostomatitis.

A

Full thickness erythema of attached and unattached gingival tissues affecting the entire mouth caused by reactivation of HSV1.

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13
Q

What are the signs/symptoms of primary herpetic gingivostomatitis ?

A

Generalised pain and erythema.
Glazed gingivae - loss of stippling, smooth gingival appearance.
Systemic symptoms - malaise, fever, lymphadenopathy.

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14
Q

What age range is primary herpetic gingivostomatitis most likely to affect ?

A

6 months to 25 years old.

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15
Q

What are the key risk factors to developing primary herpetic gingivostomatitis ?

A

Previous HSV1 infection.
Poor OH.
Immunocompromised.

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16
Q

What is the possible differential diagnoses for primary herpetic gingivostomatitis ? Explain the slight differences.

A

Erosive subtype lichen planus.

More likely to be systemically unwell and have no history of lichen planus with primary herpetic gingivostomatitis.

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17
Q

Describe how you would manage primary herpetic gingivostomatitis in primary care.

A
  1. Encourage fluid uptake and soft diet.
  2. Gentle supragingival PMPR +/- LA.
  3. Encourage OH with soft bristle toothbrush.
  4. Prescribe CHx or hydrogen peroxide mouthrinse.
  5. Prescribe Difflam spray or mouth rinse.
  6. Topical acyclovir if lesions localised to lips.
  7. Systemic signs/symptoms prescribe acyclovir.
  8. Review patient in 2 weeks (or sooner if systemic antibiotics prescribed).
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18
Q

What prescription of antiviral would you prescribe for primary herpetic gingivostomatitis ?

A

Acyclovir 200mg 5x daily 5 days.

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19
Q

Describe what an intra-oral burn might look like.

A

Erythematous halo with yellow fibrinous pseudomembrane.
Possible loss of knife edge margin.
Localised, atrophic, ulcerated lesion.

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20
Q

What are the possible causes for intra-oral burns ?

A

Aspirin - usually in buccal mucosa.
Phosphoric acid burns - after restorative treatment.
Self harm - where no other obvious explanation.

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21
Q

How should a intra-oral burn be managed ?

A
  1. Reassure.
  2. Saline mouthrinse.
  3. Advice to take care brushing.
  4. Possible Difflam.
  5. Review in 1-2 weeks.
22
Q

What are the possible causes of gingival enlargement ?

A

Drug related.
Hereditary - hereditary gingivofibromatosis.
Plaque induced.
Vitamin deficiency - i.e. Vitamin D (scurvy).
Systemic illness - i.e. Crohn’s disease.
Monocytic leukaemia.

23
Q

What drugs are related to gingival enlargement ?

A

Cyclosporin (after kidney transplant).
Calcium channel blockers i.e. nifedipine, amlodipine.

24
Q

What are the symptoms of gingival enlargement ?

A

Rolled gingival margins.
Bleeding.
Pain.
Difficulty maintaining good OH.

25
Q

What are the symptoms of monocytic leukaemia (causing gingival enlargement) ?

A

General malaise, fever, unwell.
Lethargy.
Easy bruising.
Nose bleeds.
Shortness of breath.
Generalised joint and muscle pain.

26
Q

What is the key difference between a periodontal abscess and a periapical abscess ?

A

Periodontal abscesses
- Arise from periodontium, deep pocket.
- Tooth will be vital.
Periapical abscesses
- Arise from pulpal tissues, necrotic pulp,
- Tooth will be non-vital.

27
Q

How would you manage a periodontal abscess in an emergency situation ?

A

Drainage through pocket or external incision.
Pocket debridement.
Irrigate with 0.2% Chlorhexidine.
Occlusal adjustment to relieve pain.
Antimicrobials if systemic infection.
XLA only if tooth is of hopeless prognosis.

28
Q

How would you manage a periapical abscess in an emergency situation ?

A

Drainage through XLA or extirpation.
Irrigate with 0.2% Chlorhexidine.

29
Q

How would you manage a periodontal abscess in the long-term ?

A

Periodontal therapy of pre-existing pocket to aim to regain gingival attachment.

30
Q

How would you manage a periapical abscess in the long-term ?

A

RCT and restoration.
Periradicular surgery.
XLA if unrestorable.

31
Q

What is the causes of a pericoronal abscess ?

A

Food trapping and poor plaque removal from under operculum of an unerupted tooth.
There can be occlusal trauma to the operculum.

32
Q

How would you perform emergency treatment for a pericoronal abscess ?

A

Debride.
Irrigate with 0.2% chlorhexidine.
Systemic antibiotics if systemic infection.

33
Q

What are the future treatment options for a pericoronal abscess ?

A

Extract impacted tooth.
Extract opposing tooth in opposing arch.
Operculectomy.

34
Q

What are the possible differential diagnoses for a perio-endo lesion ?

A

Root fractures.
Periodontal abscess.
Lateral periodontal cyst.

35
Q

What special investigations can be used to differentiate a root fracture from a perio-endo lesion ?

A

True occlusal or PA radiograph.
Transillumination.
Access pulp chamber.
To show detect fracture plane or might show J shaped lesion lateral to root surface.

36
Q

What special investigation will differentiate a periodontal abscess from a perio-endo lesion ?

A

Sensibility testing.
Perio-endo lesion will be non-vital.

37
Q

What special investigation will differentiate a lateral periodontal cyst from a perio-endo lesion ?

A

Sensibility testing.
Lateral periodontal cyst - tooth will remain vital.

38
Q

What special investigations would you want if you were assessing a tooth for a perio-endo lesion ?

A

PA radiograph.
Sensibility testing.
6 point periodontal chart.

39
Q

How would you treat a perio-endo lesion ?

A

FIRST VISIT
- Incision and drainage.
- Flush and debride pocket with chlorhexidine.

SECOND VISIT
- Extirpation.
- Localised root surface debridement.

THIRD VISIT
- Root treatment or peri-radicular surgery.
- Periodontal therapy.

40
Q

What are the three types perio-endo lesions ?

A

Primary endodontic lesion with secondary periodontal involvement.
Primary periodontal lesion with secondary endodontic involvement.
True perio-endo lesion.

41
Q

Describe the formation of a primary endodontic lesion with secondary periodontal involvement.

A

Initiated by long standing apical infection from necrotic pulp chamber. Infection extends coronally up the PDL causing loss of attachment.

Tooth likely to have caries or be restored.

42
Q

What size of bony defect is a primary endodontic lesion with secondary periodontal involvement likely to cause ?

A

Narrow defect.

43
Q

Describe the formation of a primary periodontal lesion with secondary endodontic involvement.

A

Infection originating from deep periodontal pocket in a patient with chronic periodontitis which extends along the root surface to the apex.

Tooth can be unrestored, restored, with or without caries.

44
Q

What size of bony defect is a primary periodontal lesion with secondary endodontic involvement likely to cause ?

A

Wider defects.

45
Q

Describe the formation of true perio-endo lesion.

A

Two independent lesions.
Most uncommon.

46
Q

For all dental abscesses, what should be the first and second line antibiotic of choice ?

A

First line - PenV (lowest spectrum).
Second line - amoxicillin.

47
Q

For all dental abscesses, what prescription of PenV should be given if signs of systemic infection or immunosuppression ?

A

500mg 4x daily for 5 days.

48
Q

If prescribing a patient PenV, what warnings should you give the patient ?

A

Diarrhoea, rashes, anaphylaxis.

49
Q

What prescription of amoxicillin should be given to a patient for any dental abscess ?

A

500mg 3x daily for 5 days.

50
Q

If prescribing a patient amoxicillin, what warnings should you give the patient ?

A

Diarrhoea, rashes, anaphylaxis.

BDS4 CDS Perio (5 decks)

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