Periodontal/ Endodontic Lesions

Question 1

what is the defining characteristic of an abscess

Answer 1

suppuration - pus - collection of dead and dying neutrophils that have gathered at a site of infections

Question 2

what is pericoronitis

Answer 2

inflammation around a partially erupted tooth

Question 3

what is a gingival abscess

Answer 3

localised to gingival margin

Question 4

what causes gingival abscess

Answer 4

could be skelf in the gum or broken piece of interdental cleaning

Question 5

what is a periodontal abscess

Answer 5

related to pre-existing deep pocket also associated with food packing and tightening of gingival margin post hygiene phase therapy
biofilm is still under in the pocket when the coronal aspect of the gingiva has healed

Question 6

what is a pericoronitis abscess

Answer 6

associated with partially erupted teeth - usually 8s

Question 7

what are endo-periodontal lesions

Answer 7

tooth is suffering from varying degrees of endodontic and periodontal disease

Question 8

what are the subdivisions of periodontal abscesses

Answer 8

acute or chronic and asymptomatic if free draining

Question 9

what are signs and symptoms of periodontal abscess

Answer 9

swelling and pain
tooth may be TTP
deep periodontal pocket
bleeding and suppuration
fever/ enlarged lymph nodes

Question 10

how are periodontal abscesses managed

Answer 10

carry out subgingival instrumentation
drain pus by incision
optimal analgesia

Question 11

when would you give antibiotics for periodontal abscess

Answer 11

if there are signs of spreading
signs of systemic involvement

Question 12

what dose of antibiotics would you prescribe for periodontal abscesses

Answer 12

penicillin V 250mg for 5 days

Question 13

what is an endo-perio lesion

Answer 13

pathological communication between the endodontic and periodontal tissues of a tooth

Question 14

how do periapical abscesses spread

Answer 14

infection via carious cavity or traumatised crown or infection via PDL goes into pulp and causes periapical infection

Question 15

what is the most common presentation of a periapical abscess

Answer 15

pus pocket at apex of tooth

Question 16

what are acute causes of endo-perio lesions

Answer 16

trauma
perforation of canals into periodontal ligaments

Question 17

what are chronic causes of endo-perio lesions

Answer 17

pre-existing periodontitis
slow and chronic progression without evident symptoms

Question 18

what are signs and symptoms of endo-perio lesions

Answer 18

deep perio pockets reaching close to apex
negative response to vitality tests
bone resorption in apical region
spontaneous pain
pus

Question 19

what are the possible scenarios where the endodontium affects the periodontium

Answer 19

necrotic pulp due to caries and then the pus of the necrotic pulp come up and out of a pre-existing pocket
furcle canals communicating with the furcation
bacteria getting into pockets of vital teeth and then goes to apex of tooth which causes pulp necrosis

Question 20

what canals do you have on the floor of the pulp chamber that can communicate with the furcation

Answer 20

furcul canals

Question 21

where are majority of lateral and accessory canals found in the tooth

Answer 21

apical third

Question 22

when might lateral canals be involved in perio-endo lesions

Answer 22

periodontal pocket causes bone loss, lateral canal is exposed to bacteria which ingresses into the pulp and causes infection

Question 23

how might endodontics might influence periodontium

Answer 23

pulpal inflammation may cause inflammatory reaction in the interradicular tissues

Question 24

what is the main communication between pulp and periodontium

Answer 24

apical foramen

Question 25

what are causes of perforation

Answer 25

extensive dental caries
resorption
operator error

Question 26

what is the developmental groove

Answer 26

invagination in root surface - if periodontium is lost the channel provides a place for accumulation of bacterial biofilm and a route for periodontitis to affect the pulp

Question 27

what is the current classification of perio-endo lesions

Answer 27

carious lesions that affects pulp and then secondarily the periodontium
periodontal destruction secondarily affects root canal
or bot events occurring at same time

Question 28

what does endo-perio lesions with root damage indicate

Answer 28

trauma

Question 29

how are endo-perio lesions treated

Answer 29

endo treatment first
periodontal therapy
offer pain control
0.2% chlorhexidine