Periodontal/Endodontic lesions and Periodontal Abscess

Question 1

Where is a gingival abscess usually found?

Answer 1

Most commonly localised to the gingival margin

Question 2

What is the most common cause of a periodontal abscess?

Answer 2

Usually related to preexisting deep pocked also associated with food packing and tightening of gingival margin post periodontal therapy

Question 3

What is a pericoronal abscess most commonly associated with?

Answer 3

Associated with partially erupted tooth most commonly 8’s

Question 4

Why might an endodontic-periodontal lesion occur

Answer 4

due to the tooth suffering from varying degrees of endodontic and periodontal disease

Question 5

What is the SDCEP definition of a periodontal abscess?

Answer 5

infection in a periodontal pocket which can be acute or chronic and asymptomatic if freely draining

Question 6

What percentage of dental emergencies are as a result of periodontal abscesses?

Answer 6

7.7% - 14%

Question 7

What type of lesion presents on the 46?

Answer 7

Perio-endo lesion

Question 8

What are the signs and symptoms of a periodontal abscess?

Answer 8

swelling
pain
tooth may be TTP in lateral direction
deep periodontal pocket
bleeding
suppuration
enlarged regional lymphnodes
fever
tooth usually vital
commonly pre-existing periodontal disease

Question 9

What are the SDCEP guidelines for management of a pt with a periodontal abscess?

Answer 9

• carry out careful sub-gingival instrumentation short of the base of the periodontal pocket to avoid iatrogenic damage; LA may be required
• if pus is present in the periodontal abscess, drain by incision or through the periodontal pocket
  -recommend optimal analgesia (ibuprofen)

Question 10

Should you prescribe antibiotics for a pt with a periodontal abscess?

Answer 10

No, unless there are signs of spreading infection or systemic involvement

Question 11

What should be recommended to a pt with a periodontal abscess?

Answer 11

recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside

Question 12

What should be carried out after acute management of a pt with a periodontal abscess?

Answer 12

following acute management, review and carry out definitive periodontal instrumentation and arrange an appropriate recall interval

Question 13

How should a periodontal abscess be treated?

Answer 13

systemic antibiotics
- only if signs of spread and systemic effects or if symptoms do not resolve with local measures
- careful root surface debridement
- penicillin V 250mg (preferred) or Amoxicillin 500mg 5 days
-OR
- Metronidazole 400mg 5 days

systemic antibiotics MUST only be used in conjunction with mechanical therapy in order to reduce the bacterial load ad disrupt the biofilm

Question 14

How can an endo periodontal lesion be described?

Answer 14

EPL is a pathological communication between the endodontic and periodontal tissues of a given tooth

Question 15

What are the acute causes of a periodontal endodontic lesion?

Answer 15

• trauma
• perforation

Question 16

What are the chronic causes of a periodontal endodontic lesion?

Answer 16

• pre-existing periodontitis
• slow and chronic progression without evident symptoms

Question 17

What are some of the signs and symptoms of a PEL?

Answer 17

• deep periodontal pockets reaching or close to the apex
• negative or altered response to pulp vitality tests
• bone resorption in the apical or furcation region
• spontaneous pain
• pain on palpation or percussion
  -pus
• mobility
• sinus tract
• crown and gingival colour alterations

Question 18

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