Periodontal/endo lesions and periodontal abscess Flashcards
what are types of Abscesses of the Periodontium?
o Gingival abscess. Localised to gingival margin
o Periodontal abscess:
o Pericoronal abscess:
o Endodontic-Periodontal Lesion:
what is periodontal abscess?
- usually related to preexisting deep pocket
- also associated with food packing
- and tightening of gingival margin post HPT
- Rapid destruction of periodontal tissues, with a negative effect on the prognosis of the affected tooth
what is pericoronal abscess?
associated with partially erupted tooth most commonly 8s
what is endodontic-periodontal lesion?
- communication between the endodontic and periodontal tissues of a given tooth
what are signs and symptoms of abscess?
o Swelling
o Pain
o Tooth may be TTP in lateral direction
o Deep periodontal pocket
o Bleeding
o Suppuration
o Enlarged regional lymphnodes
o Fever
o Tooth usually vital
o Commonly pre-existing periodontal disease
what do you do if puss is present in a periodontal abscess?
drain by incision or through the periodontal pocket.
what do the SDCEP guidelines tell you about how to treat abscess?
- sub gingival instrumentation short of base of pocket. Avoids iatrogenic damage.
- pus present = drain by incision or through pocket
- recommed analgesia
- no antibiotic unless infection or systemic involevement
- give 0.2% chlorohexidine MW until stop acute symptoms
- follow acute management, review and carry out perio instrumentation
you do not prescribe antibiotics until there are signs of what in relation to an abscess?
Do not prescribe antibiotics unless there are signs of spreading infection or systemic involvement.
what do you recommend the use of until the acute symptoms of an abscess subside?
Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.
what are the systemic antiobiotics treatment you give for periodontal abscess?
Only if signs of spread and systemic effects or if symptoms do not resolve with local measures
Careful RSD
Penicillin V 250mg(preferred) or Amoxicillin 500mg 5 days
Or
Metronidazole 400mg 5 days
what is acute endo periodontal lesion”
o Trauma
o Perforation
what is chronic endo periodontal lesion?
o Pre-existing periodontitis
o Slow and chronic progression without evident symptoms
what are the signs and symptoms of an endo periodontal lesion?
o deep periodontal pockets reaching or close to the apex
o pulp vitality = negative
o bone resorption @ apical or furcation region
o spontaneous pain
o Pain on palpation and percussion
o pus
o tooth mobility
o sinus tract
o crown, and gingival colour alterations
what is main route of communication between pulp and periodontium?
apical foramen
what is apical foramen role in communicating between pulp and periodontium?
- periradicular pathoses = Microbial and inflammatory by-products may exit the apical foramen
- apex- portal of entry - for inflammatory by-products from deep periodontal pockets to affect the pulp.
what does perforation result in?
Results in communication between the root-canal system and either peri-radicular tissues, periodontal ligament or the oral cavity.
what are causes of perforation?
extensive dental caries
resorption
operator error e.g. root-canal instrumentation or post preparation
what are the Endo‐periodontal lesions associated with trauma and iatrogenic factors?
o root/pulp chamber furcation perforation
o root fracture or cracking
o external root resorption
o pulp necrosis draining through the periodontium
what is treatment of perio-endo lesions?
Carry out endodontic treatment of the affected tooth.
Recommend optimal analgesia.
Do not prescribe antibiotics unless there are signs of spreading infection or systemic involvement.
Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.
Following acute management of the lesion, review within ten days and carry out supra- and sub-gingival instrumentation if necessary and arrange an appropriate recall interval
endo infection in mandibular molars was associated with more attachment loss in what area?
furcal area
how does endo infection in molars associated with periodontal disease enhance periodontitis progression?
by spreading pathogens through accessory canals and dentinal tubules
Does periodontal disease affect endodontics
no effect on the pulp, at least until it involves the apex
Periodontal disease on the pulp is degenerative and causes calcification, fibrosis and collagen resorption, as well as a direct inflammatory affect
Pulp is usually not significantly affected by periodontal disease until when?
until recession affects a lateral or accessory canal to the mouth.
what is Function of the periodontium?
o To attach the teeth to the jaws
o To dissipate occlusal forces
what is effective occlusal force?
- occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus,
- results in occlusal trauma and/or causes excessive tooth wear (loss).
what does occlusal trauma describe?
injury resulting in tissue changes within the attachment apparatus, including periodontal ligament, supporting alveolar bone and cementum, as a result of occlusal force(s).
what could tooth mobility indicate?
May indicate successful adaptation of the periodontium to functional demands and/or reflect the nature of the remaining attachment
Tooth mobility can be accepted, unless?
It is progressively increasing
It gives rise to symptoms
It creates difficulty with restorative treatment
what is therapy used to reduce tooth mobility?
o Control of plaque-induced inflammation.
o Correction of occlusal relations.
o Splinting.
what is primary occlusal trauma?
Injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support. It occurs in the presence of normal clinical attachment levels, normal bone levels, and excessive occlusal force(s).
what is the response of the healthy periodontium?
o PDL width increases until forces can be adequately dissipated, the PDL width should then stabilise
o Tooth mobility will be increased as a result
o This can be regarded as successful adaptation to increased demand and therefore physiological
o If demand is subsequently reduced, PDL width should return to normal
o If the demand of occlusal forces is too great or the adaptive capacity of the PDL reduced, PDL width may continue to increase
o PDL width and tooth mobility fail to reach a stable phase
o This failure of adaptation may be regarded as pathological
what is secondary occlusal trauma?
o injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced periodontal support.
o It occurs in the presence of attachment loss, bone loss, and normal/excessive occlusal force(s).
what is fremitus?
o palpable or visible movement of a tooth when subjected to occlusal forces.
what is tooth migration?
o Loss of periodontal attachment
o Unfavourable occlusal forces
o Unfavourable soft tissue profile
what is management of tooth migration?
o Treat the periodontitis
o Correct occlusal relations
o Either:
(a) Accept the position of the teeth and stabilise or
(b) Move the teeth orthodontically and stabilise
what is effect on periodontal therapy in relation to tooth mobility and occlusal forces?
o Decreased CAL gain post HPT.
o Increased Clincal Attatchment loss over time
o Mobile teeth treated with regeneration do not respond as well as non‐mobile teeth.
o But no association was drawn between mobility and occlusal forces.
studies found that teeth with occlusal discrepancies had what?
o deeper initial probing depths
o more mobility
o poorer prognoses than those teeth without occlusal discrepancies.
how to correct occlusal relations?
o Occlusal Adjustment (Selective Grinding)
o Restorations
o Orthodontics
Splinting may be appropriate when?
o Mobility is due to advanced loss of attachment
o Mobility is causing discomfort or difficulty in chewing
o Teeth need to be stabilised for debridement.
however what does splinting not influence?
o Does not influence the rate of periodontal destruction
what may splinting create?
o May create hygiene difficulties
o Is a treatment of “last resort”
Does endodontic disease affect periodontal health?
When the pulp becomes infected, it elicits an inflammatory response in the periodontal ligament at the apical foramen and/or adjacent to openings of the small portals of exit
what amtimicrobials could be used for tx of npd?
metronidazole 400mg TID 3 days
what is this?
acute periodontal abscess
