Periodontal/Endodontic lesions Flashcards
What are some different abscesses of the periodontium?
- Gingival abscess
- Periodontal abscess
- Pericoronal abscess
- Endodontic-periodontal lesion
What is a gingival abscess?
- Infection and inflammation pocket localised to gingival margin
What is periodontal abscess?
- Infection and inflammation periodontal pocket that can be acute or chronic and symptomatic if freely draining
- Usually related to preexsiting deep pocket / food packing / tightening of gingival margin post HPTnd
- Rapid destruction of periodontal tissues
- Negative effect on prognosis of affected tooth
What is pericoronal abscess?
- Infection and inflammation of tissue surrounding third molar
What is an endodontic-periodontal lesion?
-Pathological communication between endodontic and periodontal tissues of a given tooth
Signs and symptoms of periodontal abscess?
- Swelling
- Pain
- Tooth may be TTP in lateral direction
- Deep periodontal pocket
- Bleeding
- Suppuration
- Enlarged regional lymphnodes
- Fever
- Tooth usually vital
- Pre-exisiting periodontal disease
What is the SDCEP guidance for txt of periodontal abscess?
- Sub-gingival instrumentation short of base or periodontal pocket to avoid iatrogenic damage
- Use LA
- If pus drain by incision or through periodontal pocket
- Recommend analgesia
- Don’t prescribe antibiotics unless signs of spreading infection or systemic involvement
- Recommend use of 0.2% chlorhexidine mouthwash until acute symptoms subside
- Following acute management, review, carry out definitive periodontal instrumentation and arrange recall
What antibiotics can be prescribed for periodontal abscess?
- Only prescribe is evidence of systemic involvement or spreading infection
- Penicillin V 250mg or Amoxicillin 500mg 5 days
- Metronidazole 400mg 5 days (if allergy to Pen V)
What are the different types of endo-periodontal lesions?
Acute
- Trauma
- Perforation
Chronic
- Pre-existing perio
- Slow and chronic progression without evident symptoms
What are the signs and symptoms of endo-periodontal lesions?
- Deep periodontal pockets reaching or close to apex
- Negative or altered response to pulp vitality tests
- Bone resorption in apical or furcation region
- Spontaneous pain
- Pain on palpation and percussion
- Purulent exudate
- Tooth mobility
- Sinus tract
- Crown and gingival colour alterations
Can exposed dentinal tubules cause pulpal inflammation?
- Studies found exposure of dentin at CEJ occurs in 18-25% teeth
- If containing bacterial plaque
What are lateral or accessory canals?
- A channel leading from root pulp laterally through the dentin into periodontal tissue
- Can be found anywhere in root but most common in apical third
What is the percentage of teeth that have lateral or accessory canals?
- 30-40%
How can lateral canals lead top pulpal inflammation?
- Exposed canal due to bone resorption and bacteria can get into pulp
- Can get in through the periodontal space if bacteria and infection has occurred here
How can furcal canals lead to pulpal inflammation?
- Furcation of molars direct pathway of communication between pulp and periodontium
- Microorganisms and toxic by products
What is the main route of communication between pulp and periodontium and what can this cause?
- Through apical foramen
- Microbial and inflammatory by-products may exit apical foramen causing periradicular pathoses
- Apex if portal of entry for inflammatory by products from deep periodontal pockets to affect the pulp
What does perforation lead to?
- Communication between root-canal system and either peri-radicular tissues, periodontal ligament or oral cavity
What are the causes of perforation?
- Extensive dental caries
- Resorption
- Operator error e.g. root canal instrumentation or post preparation
What is a developmental groove?
- Invagination (cavity formed by being turned inside out or folded back)
- Vertical developmental radicular groove
- Especially upper incisors
How can a developmental groove lead to periodontitis?
- Epithelial attachment breached
- Groove becomes contamiinated
- Self sustaining infrabony pocket forms
- Pocket accumulates bacterial biofilm
- Microorganisms travel down and can infect periodontium and can progress into pulp
What is the SDCEP treatment of perio-endo lesions?
- Endodontic treatment on affected tooth
- Recommend optimal analgesia
- Don’t prescribe antibiotics unless signs of spreading infection or systemic involvement
- Recommend 0.2% chlorhexidine mouthwash until acute symptoms subside
- Review within 10 days and carry out supra- and sub-gingival instrumentation if needed
- Arrange recall
In what instance is the pulp affected by periodontal disease?
- Only affected when recession affects lateral or accessory canal
- Bacteria through lateral or accessory canal into pulp cause chronic inflammation and possibly pulp necrosis
What are some causes of endo-periodontal lesions with root damage?
- Root fracture or cracking
- Root canal or pulp chamber perforation
- External root resorption
What are the grades of endo-periodontal lesions without root damage?
Grade 1 - Narrow deep periodontal pocket in 1 tooth surface
Grade 2 - Wide deep periodontal pocket in 1 tooth surface
Grade 3 - Deep periodontal pockets in more than 1 tooth surface
