Periodontal/endo lesions and periodontal abscess Flashcards

1
Q

what are types of Abscesses of the Periodontium?

A

o Gingival abscess. Localised to gingival margin
o Periodontal abscess:
o Pericoronal abscess:
o Endodontic-Periodontal Lesion:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is periodontal abscess?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is pericoronal abscess?

A

associated with partially erupted tooth most commonly 8s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is endodontic-periodontal lesion?

A
  • communication between the endodontic and periodontal tissues of a given tooth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are signs and symptoms of abscess?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what do you do if puss is present in a periodontal abscess?

A

drain by incision or through the periodontal pocket.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what do the SDCEP guidelines tell you about how to treat abscess?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

you do not prescribe antibiotics until there are signs of what in relation to an abscess?

A

Do not prescribe antibiotics unless there are signs of spreading infection or systemic involvement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what do you recommend the use of until the acute symptoms of an abscess subside?

A

Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the systemic antiobiotics treatment you give for periodontal abscess?

A

 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is acute endo periodontal lesion”

A

o Trauma
o Perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is chronic endo periodontal lesion?

A

o Pre-existing periodontitis
o Slow and chronic progression without evident symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the signs and symptoms of an endo periodontal lesion?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is main route of communication between pulp and periodontium?

A

apical foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is apical foramen role in communicating between pulp and periodontium?

A
  • 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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what does perforation result in?

A

Results in communication between the root-canal system and either peri-radicular tissues, periodontal ligament or the oral cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are causes of perforation?

A

 extensive dental caries
 resorption
 operator error e.g. root-canal instrumentation or post preparation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the Endo‐periodontal lesions associated with trauma and iatrogenic factors?

A

o root/pulp chamber furcation perforation
o root fracture or cracking
o external root resorption
o pulp necrosis draining through the periodontium

19
Q

what is treatment of perio-endo lesions?

A

 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

20
Q

endo infection in mandibular molars was associated with more attachment loss in what area?

A

furcal area

21
Q

how does endo infection in molars associated with periodontal disease enhance periodontitis progression?

A

by spreading pathogens through accessory canals and dentinal tubules

22
Q

Does periodontal disease affect endodontics

A

 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

23
Q

Pulp is usually not significantly affected by periodontal disease until when?

A

until recession affects a lateral or accessory canal to the mouth.

24
Q

what is Function of the periodontium?

A

o To attach the teeth to the jaws
o To dissipate occlusal forces

25
Q

what is effective occlusal force?

A
  • occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus,
  • results in occlusal trauma and/or causes excessive tooth wear (loss).
26
Q

what does occlusal trauma describe?

A

injury resulting in tissue changes within the attachment apparatus, including periodontal ligament, supporting alveolar bone and cementum, as a result of occlusal force(s).

27
Q

what could tooth mobility indicate?

A

May indicate successful adaptation of the periodontium to functional demands and/or reflect the nature of the remaining attachment

28
Q

Tooth mobility can be accepted, unless?

A

 It is progressively increasing
 It gives rise to symptoms
 It creates difficulty with restorative treatment

29
Q

what is therapy used to reduce tooth mobility?

A

o Control of plaque-induced inflammation.
o Correction of occlusal relations.
o Splinting.

30
Q

what is primary occlusal trauma?

A

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).

31
Q

what is the response of the healthy periodontium?

A

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

32
Q

what is secondary occlusal trauma?

A

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).

33
Q

what is fremitus?

A

o palpable or visible movement of a tooth when subjected to occlusal forces.

34
Q

what is tooth migration?

A

o Loss of periodontal attachment
o Unfavourable occlusal forces
o Unfavourable soft tissue profile

35
Q

what is management of tooth migration?

A

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

36
Q

what is effect on periodontal therapy in relation to tooth mobility and occlusal forces?

A

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.

37
Q

studies found that teeth with occlusal discrepancies had what?

A

o deeper initial probing depths
o more mobility
o poorer prognoses than those teeth without occlusal discrepancies.

38
Q

how to correct occlusal relations?

A

o Occlusal Adjustment (Selective Grinding)
o Restorations
o Orthodontics

39
Q

Splinting may be appropriate when?

A

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.

40
Q

however what does splinting not influence?

A

o Does not influence the rate of periodontal destruction

41
Q

what may splinting create?

A

o May create hygiene difficulties
o Is a treatment of “last resort”

42
Q

Does endodontic disease affect periodontal health?

A

 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

43
Q

what amtimicrobials could be used for tx of npd?

A

metronidazole 400mg TID 3 days

44
Q

what is this?

A

acute periodontal abscess