Periodontal Emergencies in General Practise (2017)

Question 1

What is a gingival abscess & give the clinical features?

Answer 1

Localised purulent infection that involves the marginal gingiva or interdental papillae
- rapidly expanding localised area of swelling
- may be shiny and smooth
- suppuration may be present
- usually painful and tender to palpate

Question 2

What is the aetiology of gingival abscesses?

Answer 2

• subgingivally impacted foreign objects (eg piece of nail in habits)

Question 3

What is the emergency management of a gingival abscess?

Answer 3

• Incision, drainage and irrigation with saline to relieve acute symptoms.
• Mechanical debridement of any foreign bodies
• Short term use of chlorhexidine MW (0.2%)

Question 4

What is a periodontal abscess?

Answer 4

A localised accumulation of pus within the gingival wall of a periodontal pocket resulting in the destruction of collagen fibre attachment and loss of nearby alveolar bone (accounts for 10% of dental emergencies)

Question 5

How does a periodontal abscess present?

Answer 5

• ovoid elevation in gingival along lateral part of root
• deep pocket abscesses may present as diffuse swelling / red area
• always usually associated with a deep periodontal pocket with bleeding & tenderness on probing
• suppuration via fistula or via pocket itself
• increased tooth mobility & TTP

Question 6

Sensibility testing results of a pt with a periodontal abscess would be?

Answer 6

Positive response from tooth as POCKET is infected, not tooth itself

Question 7

What is the emergency management of a periodontal abscess?

Answer 7

• drainage via pocket or with incision
• debridement of periodontal pocket
• only systemic antibiotics if signs of spreading infection
• XLA if the tooth has hopeless prognosis for periodontal or restorative reasons

Question 8

What is pericoronitis ?

Answer 8

Inflammation of the soft tissues surrounding the crown of a partially erupted tooth

Question 9

What is a peri-coronal abscess?

Answer 9

Localised accumulation of pus within the overlying gingival flap surrounding the crown of a partially erupted tooth

Question 10

How does pericoronitis/peri-coronal abscess present?

Answer 10

Lesion that is:
- red
- swollen
- potentially suppurative
- painful to touch

Swelling of cheek at angle of mandible

Trismus

Pain radiating to ear

Question 11

What is the aetiology of pericoronitis?

Answer 11

Overlying operculum harbours accumulation of debris and bacteria

Question 12

What is the emergency management of pericoronitis/peri-coronal abscess?

Answer 12

• LA
• irrigation of operculum
• antibiotics ONLY if signs of spreading systemic infection

Question 13

What is a perio-endo lesion or abscess?

Answer 13

Localised, circumscribed areas of infection originating in the periodontal and/or pulpal tissues
- communication between periodontal pocket and pulp

Question 14

How do perio-endo lesions present?

Answer 14

Abscess associated with:
- deep pocket surrounding a non-vital tooth
- smooth/shiny swelling of gingiva or mucosa present
- potential purulent exudate
- TTP
- maybe mobile

Question 15

What is the aetiology of a perio-endo lesion?

Answer 15

Can either be:
- pulpal inflammatory disease expressed via PDL pocket
- infection of periodontal pocket communicating to pulp via accessory canals

Question 16

What is the emergency management of perio-endo lesions?

Answer 16

• extripation of pulp and RCT
• debridement of pocket
• incision of abscess if needed