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