9 - Perio abscess and perio endo lesions

Question 1

What is pus?

Answer 1

Dead and dying neutrophils killed by infection

Question 2

What are the different types of abscess of the periodontium?

Answer 2

• gingival
• periodontal
• pericoronal
• endodontic-periodontal lesion

Question 3

Describe a gingival abscess.

Answer 3

Localised to gingival margin in the pocket or caused by local trauma, no LOA.

Question 4

Describe a periodontal abscess.

Answer 4

• related to preexisting deep pocket
• associated with food packing and tightening of gingival margin after HPT
• inadequate cleaning of base of pocket and bacteria is trapped

Question 5

Describe a pericoronal abscess.

Answer 5

Associated with partially erupted teeth, usually 8s.

Question 6

Describe an endodontic-periodontal abscess.

Answer 6

Tooth that is suffering both endodontic and periodontal diseases of varying degrees.

Question 7

What are the signs and symptoms of a periodontal abscess? (9)

Answer 7

• swelling
• pain
• TTP in lateral direction
• deep pocket
• bleeding
• pus formation
• enlarged lymph nodes in region
• fever
• tooth is usually vital

Question 8

What is the management of a periodontal abscess?

Answer 8

• careful sub-gingival instrumentation +/- LA
• drain pus by incision or via pocket
• recommend analgesia
• 0.2% chlorohexadine mouthwash

Question 9

When should you prescribe antibiotics for a periodontal abscess?

Answer 9

• fever over 38
• altered consciousness
• increased respiratory rate, tachycardia
• trismus

Question 10

What are the different types of perio-endo lesions?

Answer 10

• acute (trauma or perforation)
• chronic (preexisting periodontitis)

Question 11

What are the signs and symptoms of a endodontic-periodontal abscess?

Answer 11

• deep pockets close to apex
• negative/altered response to pulp sensitivity test
• bone resorption around apex/furcation
• spontaneous pain
• pain on palpation/percussion
• tooth mobility
• sinus tract

Question 12

What are the possible routes of communication between the pulp and the PDL?

Answer 12

• lateral, furcal and accessory canals
• deep pockets reaching apex
• deep pockets involving the furcation
• exposed dentine tubules at ECJ
• apical foramen
• perforation

Question 13

What is a furcal canal?

Answer 13

• accessory canal from the pulp chamber in the direction of the furcation
• not all furcal canals extend fully to the floor of the furcation

Question 14

How is the apical foramen involved in perio-endo lesions?

Answer 14

• main route of communication between pulp and PDL
• bacteria can enter the pulp from the PDL or bacteria can exit from the pulp to the PDL
• inflammatory by-products of periodontitis can access the pulp

Question 15

What is a lateral canal?

Answer 15

• found in many teeth, typically in the apical third
• not all lateral canals are involved in perio-endo lesions
• involvement is more likely if there are deep pockets and lateral canals are exposed to the oral cavity

Question 16

What causes a perforation?

Answer 16

• operator error when carrying out RCT or placing a post crown
• gross caries
• root resorption

Question 17

What is a perforation?

Answer 17

Communication between root canal system and the PDL, peri-radicular tissue or oral cavity.

Question 18

How do developmental grooves cause perio-endo lesions?

Answer 18

• invagination of the external root surface which usually has epithelial lining but can progress to a deep infrabony pocket if LOA
• if pocket extends to the apex, bacterial biofilm accumulates and can contaminate pulp

Question 19

What are the current classifications of perio-endo lesions?

Answer 19

• carious lesion that affects the pulp and secondarily the periodontium
• periodontal destruction that secondarily affects the root canal
• both events occurring at the same time

Question 20

What is the recommended management of perio-endo lesions?

Answer 20

• endodontic treatment of affected tooth
• optimal analgesia advice
• 0.2% chlorohexadine mouthwash for acute symptoms
• after acute management, supra- and sub-gingival instrumentation within 10 days