Week 7 - Acute Periodontal Lesions and Mucogingival Conditions Flashcards
what are the acute periodontal lesions
- periodontal abscesses
- necrotizing periodontal diseases
- endo perio lesions
what percentage of all emergency patients are dental emergency patients
7-14%
what is the prevelance of dental emergencies in the hospital
3rd most common
______ of untreated periodontal patients make up dental emergencies
60%
____ of patients in active periodontal treatment make up dental emergencies
13.5%
_____ of patients in periodontal maintenance make up dental emergencies
37%
what is the etiology of periodontal abscess
-pulp necrosis
- periodontal infections
- pericoronitis
- trauma
- surgery
- foreign body impaction
what is a periodontal abscess
localized accumulation of pus located within the gingival wall of the periodontal pocket with an expressed periodontal breakdown occurring during a limited period of time and with easily detectable clinical sympotms
what are the sequence of events leading to abscess formation
- occlusion of existing periodontal pocket
- bacterial invasion of soft tissue wall
- leukocytic infiltration (neutrophils)
- vascular thrombosis
- edema and swelling
- tissue necrosis and liquefaction
- collagenolysis and bone resorption
- production of purulent exudate
what are the most common symptoms of acute periodontal disease in order of decreasing frequency
- pain
- swelling and edema
- lymphadenopathy
- fever
multiple abscess formation is often a manifestation of:
- diabetes (uncontrolled or undiagnosed) : most of cases have this as a cause
- AIDS (compromised immune system)
- depressed immune system (steroid therapy, chemotherapy)
what is the microbiology in an abscess
- 65% of the microbial flora is gram negative and anaerobic
- bacteria that produce proteinases, as P.gingivalis and P. intermedia are important in the pathogenesis of the periodontal abscess since they increase they availability of nutrients, and thereby increase the number of bacteria within the abscess environment
what species are present in the periodontal abscess
- treponema (spirochetes)
- fusobacterium nucleatum
- prevotella intermedia
- prophyromonas gingivalis
- peptostreptococcus micros
- tannerella forsythia
- candida albicans
what is the histropathology of the periodontal abscess
- acute inflammatory infiltrate
- vascular hyperemia and thrombosis
- lysis of the colalgen matrix in the lamina propria and the gingival fibers
- ulceration and apical proliferation of JE
- osteoclastic mediated bone resorption
periodontal abscess could represent a period of disease exacerbation due to:
the presence of a tortuous pocket, furcation involvement, or vertical defect
when does an acute exacerbation of periodontal abscess happen
- in untreated periodontitis
- non-responsive to periodontal therapy
- patients on supportive periodontal therapy
what should you do after treatment of periodontal abscess
- post-scaling
- post-surgery
- post medication: antimicrobials and nifedepine
what are the causes of periodontal abscess in non periodontitis patients
- impaction of foreign bodies
- harmful habits
- orthodontic factors
- gingival enlargement
- alteration of the root surface including:
- dens invaginatus
- cemental tears or enamel pearls
- iatrogenic conditions such as perforations
- severe root damage: vertical root fracture or cracked tooth syndrome
- external root resorption
what are the clinical signs of periodontal abscess
- pain
- localized swelling and fluctuence
- purulent exudate
- deep periodontal pocket-
- tooth exhibits vital pulp
- may present with a fistula
- tooth mobility
- sensitivity to percussion
- low grade fever
- lymphadenopathy
what are the differential diagnoses for periodontal abscess
- periapical abscess
- acute pulpitis
- tooth or root fracture
- pericoronitis
- lateral periodontal cyst
- gingival cyst
what are the abscess complications
- tooth loss- up to 45% of teeth with periodontal abscesses in maintenance are extracted
- bacteremia following abscess treatment
- chronic or episodic bacteremia from untreated perio disease
what are the tx for abscess
- nonsurgical drainage and debridement with local anesthetic
- surgical drainage for large abscess
- surgical therapy with flat reflection, debridement with ultrasonic, sutures
- antibiotics if systemic infection indicated by fever or lymphadenopathy
- reevaluation and any further needed therapy
how are periodontal abscesses diagnosed
- health history and medications
- dental history
- current periodontal status
- current status of affected tooth
- periapical radiographs
- clinical exam
- determine etiology
what should you determine to dx current status of the affected tooth
- cold and EPT tests vital
- pain on percussion
what are the signs on clinical exam to make dx of periodontal abscess
- redness
- swelling
- purulent discharge
- lymphadenopathy
what are the two types of treatment for the perio abscess
- closed approach
- open approach
what is the closed approach
- incision and drainage through the pocket
- root planning to depth of the sulcus
what is the open approach
- sulcular incisions and full thickness flap
- remove all visible soft and hard deposits from root and adjacent bone
- replace flap and suture closed
are systemic antibiotics usually needed in the tx of perio abscess
no
what are the postoperative therapies for perio disease
- home care
- prescribe analgesics
- re-evaluation
- frequently monitor radiographically and clinically periodontal disease
what are the acute periodontal diseases
- acute periocoronitis
- acute periodontal abscess
- acute herpetic gingivostomatitis
- acute necrotizing ulcerative gingivitis
- endo- perio lesions
what is the role of keratinized gingiva
- highly debated over many years
- possible to maintain periodontal health in the absence of keratinized gingiva
all surfaces with less than _____ of keratinized gingiva exhibit clinical inflammation even in the absence of plaque
2.0mm
when a narrow band of keratinized gingiva is present, sites with a thinner phenotype:
have a greater tendency to progress
what is the normal amount of keratinized tissue
need 2mm keratinized, 1mm attached
what is the periodontal phenotype of mucogingival deformities and conditions
- thin scalloped
- thick scalloped
- thick flat
what is the periodontal phenotype based on
- gingival phenotype
- bone morphotype
- tooth position
what is the keratinized tissue width for thick biotype and thin phenotype
- 5.72mm for thick biotype
- 4.15mm for thin phenotype
what is the range of gingival thickness
0.63mm-1.24mm
what is the bone morphotype for thin biotype and thick/average phenotype
-0.34mm for thin biotype
- 0.754 for thick/average phenotype
what is gingival recession
apical migration of the gingival margin with concomitant exposure of the root surface
what is the prevalence of gingival recession
- 54.5% of young adults
- 100% middle aged early adults
- average prevalance of 78.6%
what can be the result of gingival recession
- decreased vestibular depth
- lack of keratinized gingiva
- aberrant frenum/muscle position
what are the results of gingival excess
- pseudopocket
- inconsistent gingival margin
- excessive gingival display
- gingival enlargement
what are the normal colors
- physiologic pigmentation
- subtle changes in color, contour and consistency
what are the tooth conditions associated with gingival recession
- non carious cervical lesions (NCCL)
- root caries
what are the descriptors of Class A step - CEJ
CEJ detectable without step
what are the descriptors for Class A CEJ step +
CEJ detectable with step
what are the descriptors of Class B CEJ with step -
CEJ undetectable without step
what are the descriptors for Class B CEJ Step +
CEJ undetectable with step
what are the most common mucogingival defects in daily practice
- gingival recessions
- inadequate zone of keratinized gingiva
what are the predisposing factors for mucogingival conditions
- periodontal biotype and attached gingiva
- the impact of tooth brushing
- the impact of cervical restorative margins
- the impact of orthodontics
- other conditions
what are the diagnostic considerations for mucogingival conditions
- recession depth and gingival thickness
- modern recession classification
- recession type
what is recession type 1 described as
gingival recession with no loss of interproximal attachmnet. interproximal CEJ was not detected eith on the mesial or distal aspect of the tooth
what is recession type 2 described as
gingival recession associated with loss of interproximal attachmnet. the amount of interproximal attachment loss was less or equal to the buccal attachment loss
what is recession type 3 described as
gingival recession with the loss of interproximal attachment
- interproximal attachment loss is greater than the buccal attachment loss
what is the cairo classification for gingival recession
- treatment oriented
- RT 1 (miller class I and II): 100% root coverage can be predicated
- Cairo RT 2 (overlapping Miller class III): mixed results
- Cairo RT 3(overlapping Miller class IV):full root coverage is not achievable
