W2: Perio classification: Other conditions affecting the periodontium Flashcards
What are the categories for other conditions affecting the Periodontium in the updated classification system?
2 main headings
1. PD conditions, Gingival
2. Periodontitis
3. Other
NEW= IMPLANTS (old one did not have implants)
IN OTHER CONDITIONS
- system
- absecess
- muco
-trauma
What are the types of Abscess, and what is an abscess?
A= swollen/inflamed area within body tissue containing pus buildup (aka exudate/suppuration)
- perio= around, dont= tooth (abscess around tooth)
- PD: bone loss, loss of AB supporting tooth, complication of adv gum disease
2.PA: around root point. untx dental caries/crack/trauma. occlusal -> pulp -> apex being drained= pimple - Gingival A: trapped food or foreign body in gingival sulcus
- crown. teeth unerupted, impacted, esp lower wisdoms or 7s. not erupting straight, trapped, gingiva receeds. when in limbo, lil flap of tissue (OPERCULUM) operculum is loose and food/B trapped under it
a) How will Periodontal abscesses present?
b) what LRF increase PD abscess?
common dental emergency ASAP care
happens bc accumulation of bacteria/ foreign body
- pain, swell, pus= funny taste
LOCAL RF
- tooth morphology: groove in teeth, crowding (more plaque), foreign Obj (e.g. fingernail, popcorn kernal)
Periodontal abscesses Dx and Mx
Diagnose
- thorough medhx + dental hx- idea of what has happened, shx can help
- oral exam: look for swelling around area, pimple, probe around teeth, mobility= bone loss (beach umbrella in sand, no sand= flapping)
- pA: See apex of tooth, see if abscess is draining, look for bone loss, widening of PDL space
Mx: what OHT do?
- acute: drain abscess (not by cutting it), debride it (e.g. WT pain, LA and debride- clean with ultrasonic or hand scaler + warm saline or savacol rinse with monoject)
- maybe Ab (amoxicillin)
- Periodontal therapy
Clinical presentation
- vertical bone loss mesial 47
- sometimes pain not be felt if abscess drained (bit of relief)
Clinical presentation
may be residual lesion where pus was.
diastama on tooth- accumulation plaque/ hard to clean
What lesion is challenging to diagnose?
hard to dx and tx
rare
image: GP inserted, PA, to determine where this abscess is draining from.
- related to periodontium and roots of 25. pulp infected, presenting on buccal surface
thus endo-perio lesion
NOTE: when doing dx, take a pulp test.
Positive pulp test= abscess is from periodontium
Negative= root is dying= endo problem
Perioendo lesions are graded by looking at the root. What are the grades?
- can happen with root or not damage
- graded
- perioendo lesion grade 3 = deep periopocket in more than 1 tooth surface
Mucogingival deformities and conditions around teeth
types
How many frenulum in mouth?
- we have a few, under tongue, under lips
- right has higher attachment, causes pulling effect on lower anteriors= inflammation (common)
Non-carious cervical lesions
Non-carious cervical lesions
- along CEJ/neck of tooth
- happens in case of acid erosion
- ‘caving’ concavity effect on 23, happens when we have gingival recession
- NON CARIES. lesion but not due to decay but maybe occlusal trauma, abrasion, erosion. (tx: depends, might be ok, only fill if sensitivity)
- 23 concavity= high risk decay even tho rn its non carious lesion. plaque could get stuck and break down enamel. thats why look at pt brushing habits.
Patient aesthetic concern
screening index mainly in cosmetic/ ortho clinics for aesthetics. all about gum contour, interdental space, angulation, colour resto
- term to describe injury to tissue (AB, PDL, cementum)
- reduced periodontium
- note: don’t get perio if you bite hard, but if you have perio and bite hard it could make perio worse.
- OF= zone of tension. AB density increases, thick lamina dura. wideth periodontal space increase
white= lamina dura (thick bc of occlusal force)
red: periodontal ligament space wide)
green: vert. bone loss.
Clinical and radiographic indicators of occlusal trauma
- Fremitus
- Mobility
- Occlusal discrepancies
- Wear facets
- Tooth migration
- Fractured tooth
- Thermal sensitivity
- Discomfort/pain on chewing
- Widened PDL space
- Root resorption
- Cemental tear
Indicators of occlusal trauma caused by fremitis and tooth mobility:
vibration, palpable, movement of tooth when occlusal force.
best way to test, is
1. tip fingernail on tooth, get pt to bite down, firm close, grind side to side. if you feel vibration there is fremitus (take x-ray and hx)
2. mobility= end of mirror
Indicators of occlusal trauma caused by OD and WF:
- A: OD- pointing to premature contact on occlusal, so pt bite and hits there, tx: reduce high spot= distribute weight (like high heel, all weight puts to step, but flats it is distributed)
- WF: canines are occluding together. touch and match like jigsaw. wear facet on incisal. Look in oral exam for wear facets.
Indicators of occlusal trauma in TM
Tooth migration
- hitting palate of uppers= really bad
- teeth flare cause by Occlusal trauma makes worse… + periodontal disease
Indicators of Occlusal trauma
widening of periodontal ligament.
tooth is taking all the force.
Occlusal trauma: fracture, root resorption
- FT: cusp fractured
-RR: apex resorb probs due to ortho or occlusal trauma bc teeth moved too quickly, can see retainer or splinted bc mobile? just need to know it presents in x-ray like bluntening of roots
cemental tear
rare
C: PA: 79 male constant abscess on 31 after RCT. no dhx trauma. deep pocket lingual. splinted. Radioluscent apex 31. cleaning of tooth. abscess subside. came back. EXO,
d: buccal
e: lingual. arrow is lil tear on cementum of tooth. take photo of perioprobe with lesion (and when monitoring nv, do same for comparison)
use probe next to lesion to measure.
Tooth and prostheses related factors
- biological width: distance est by junctional Epithelium. height of deepest sulcus poitn and height of AB
- cerv. enamel projections: extension of enamel, beyond CEJ, extend into furcation of tooth, buccals of molars, looks like overgrowth, beyond CEJ to furcation point
-
16?
enamel pearls lil bump/overgrowth, lil AB bone loss. diff to cervical enamel projection (more overgrowth of enamel, not so droplet like)
-
overhangs. amalgam.
buccal restoration class 5= circular = manmade
-
violation of biological width happens on soft tissue bc of calculus.
(depth of pocket to AB)
e.g: happens in veneer. veneer might go in sulcus. bulbous gingiva. veneer extends into the sulcus. explain to pt: redo work.
note: abrasion is more on hard sf.
1
tooth position.
crowding cause plaque
-
- c
- LA debridement, savacol/irrigate area rinse, pA, refer to DO
- b
you see a potential endoperio lesion. pulp test performed. what is diff between +/- result?
NOTE: when doing dx, take a pulp test.
Positive pulp test= abscess is from periodontium
Negative= root is dying= endo problem
