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BDS3 Periodontology > Periodontal/Endodontic lesions > Flashcards

Periodontal/Endodontic lesions Flashcards

1
Q

What are some different abscesses of the periodontium?

A
  • Gingival abscess
  • Periodontal abscess
  • Pericoronal abscess
  • Endodontic-periodontal lesion
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2
Q

What is a gingival abscess?

A
  • Infection and inflammation pocket localised to gingival margin
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3
Q

What is periodontal abscess?

A
  • 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
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4
Q

What is pericoronal abscess?

A
  • Infection and inflammation of tissue surrounding third molar
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5
Q

What is an endodontic-periodontal lesion?

A

-Pathological communication between endodontic and periodontal tissues of a given tooth

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6
Q

Signs and symptoms of periodontal abscess?

A
  • 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
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7
Q

What is the SDCEP guidance for txt of periodontal abscess?

A
  • 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
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8
Q

What antibiotics can be prescribed for periodontal abscess?

A
  • 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)
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9
Q

What are the different types of endo-periodontal lesions?

A

Acute
- Trauma
- Perforation
Chronic
- Pre-existing perio
- Slow and chronic progression without evident symptoms

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10
Q

What are the signs and symptoms of endo-periodontal lesions?

A
  • 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
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11
Q

Can exposed dentinal tubules cause pulpal inflammation?

A
  • Studies found exposure of dentin at CEJ occurs in 18-25% teeth
  • If containing bacterial plaque
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12
Q

What are lateral or accessory canals?

A
  • 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
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13
Q

What is the percentage of teeth that have lateral or accessory canals?

A
  • 30-40%
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14
Q

How can lateral canals lead top pulpal inflammation?

A
  • 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
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15
Q

How can furcal canals lead to pulpal inflammation?

A
  • Furcation of molars direct pathway of communication between pulp and periodontium
  • Microorganisms and toxic by products
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16
Q

What is the main route of communication between pulp and periodontium and what can this cause?

A
  • 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
17
Q

What does perforation lead to?

A
  • Communication between root-canal system and either peri-radicular tissues, periodontal ligament or oral cavity
18
Q

What are the causes of perforation?

A
  • Extensive dental caries
  • Resorption
  • Operator error e.g. root canal instrumentation or post preparation
19
Q

What is a developmental groove?

A
  • Invagination (cavity formed by being turned inside out or folded back)
  • Vertical developmental radicular groove
  • Especially upper incisors
20
Q

How can a developmental groove lead to periodontitis?

A
  • 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
21
Q

What is the SDCEP treatment of perio-endo lesions?

A
  • 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
22
Q

In what instance is the pulp affected by periodontal disease?

A
  • Only affected when recession affects lateral or accessory canal
  • Bacteria through lateral or accessory canal into pulp cause chronic inflammation and possibly pulp necrosis
23
Q

What are some causes of endo-periodontal lesions with root damage?

A
  • Root fracture or cracking
  • Root canal or pulp chamber perforation
  • External root resorption
24
Q

What are the grades of endo-periodontal lesions without root damage?

A

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

BDS3 Periodontology (7 decks)

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