Acute Perio Conditions_19th Feb 1pm Flashcards
(29 cards)
What are the different possible types of acute perio conditions?
- Periodontal Abscess
- Periocoronitits
- Perio/endo lesions
- NUG/NUP
- Ulcerations/oral pathology on gingiva
What is a periodontal abscess?
- Formation of deep tortuous pockets–>leads to bacterial build up in pocket forming abscess
- Pressure exerted by bacterial/pus build up may cause spread to adjacent periodontal tissue
- Changes in host defence, microflora, bacterial virulence may make it pocket lumen insufficient for draining suppuration
At what stages of periodontal disease can an abscess occur?
- Acute exacerbation of untreated perio
- Periodontal therapy (dislodgement of calculus deeper into pocket)
- Refractory periodontitis
T/F Using systemic antibiotics to treat in pt with advanced perio without gingival debridement can cause perio abscess
T
Can develop multiple
Thought to be due to superinfection
Where are periodontal abscesses frequently found?
Furcations
What factors can predispose diabetic patients to periodontal abscess?
- Lowered host resistance
- Impaired cellular immunity
- Decreased leukocyte chemotaxis, phagocytosis and bactericidal activity
What are some possible causes of periodontal abscess in the abscence of periodontitis?
- Impaction of foreign bodies (e.g. toothpicks, popcorn kernals, getting lodged in gingiva)
- Local root morphology (e.g. cervical enamel tears)
What can you notice clinically with periodontal abscess?
- Ovoid elevation of gingiva along lateral aspect of root
- Gingiva edematous and red, smooth shiny surface
- Calculus normally present
- Pus may be expressed with gentle digital pressure
What are the possible symptoms of periodontal abscess?
- Think about location under abscess
- Increased tooth mobility
- Elevation of tooth in socket
- Tenderness during mastication (and during percussion)
- Slight discomfort to severe pain and swelling
- Tightness in gums
- Systemic symptoms sometimes present (fever, malaise_
What do you notice radiographically with periodontal abscess?
- Bone loss
- May be widening of PDL or severe bone loss
What are the differential diagnosis of periodontal abscess?
- Crack
- Endodontic abscess drainaige
- Root fracture
What is the treatment for peridontal abscess?
- For pain relief: LA, handscale as best as possible, irrigate with saline
- For full treatment: access surgery flap to fully debride
- If systemic involvement: antibiotics
- Metronidazole, 400mg, three times daily, 5-7days
- If severe, add amoxicillin 500mg, 3x daily, 5-7days
What is pericorinitis?
- Infection in tissue and mucosa surrounding partially erupted tooth
- Usually occurs around wisdom teeth
What are the symptoms for mild pericoronitis?
- Pain
- Localised Swelling
- Pus discharge
- Foul odour + taste
What are the symptoms for severe pericoronitis?
- Difficulty swallowing
- Limited opening
- Enlarged lymph nodes
- Fever
- Facial cellulitis
What is the treatment for pericoronitis?
Debride area under operculum as fully as possible + irrigate with chlorhex and saline
Place pt on chlorhex for a week and explain importance of keeping tissues clean
If major systemic sympotms, metronidazole + amoxicillin or penicillin V (phenoxymethylpenicillin) for 1 week
Then consider: Is it recurring + will tooth erupt into good position? Then decide:
- Extract
- Operculectomy
- Wait and monitor
What is NUG?
- Rapidly destructive
- non-communicable
- gingival infection of complex aetiology
What are the predisposing factors to NUG?
Local:
- Oral hygiene
- Plaque retentive factors (overhangs, crowded teeth, calculus)
- Cigarette smoking
Systemic:
- Stress
- Nutrition
- Hormonal imbalance
- Immunosuppression
What are the clinical features of NUG?
- Necrosis of crest of marginal tissues
- Spontaneous bleeding
- Halitosis
- Pain
- Grey pseudomembrane
- Punched out/cratered interdental papillae
What are the symptoms of NUG?
- Metallic taste
- Pain
- Halitosis
- Systemic symptoms (lymphadenopathy, fever, malaise)
What other diseases can be confused with NUG? (Study this later)
- Acute herpetic gingivostomatitis
- Desquamative gingivitis
- HIV-related periodontitis
- Streptococcal gingivostomatitis
- Advanced marginal gingivitis
- aphthous stomatitis
- acute leukemia
- dematoses
What is the treatment for NUG?
- Debridement under LA
- Irrigate with betadine
- Chlorhex mouthrinse bds (2x per day)
- Investigate causative factors
What is NUP?
- Progression of NUG necrosis to affect PDL and alveolar bone as well as gingival tissues
- Extremely severe pain
- Commence at ID papilla, results in interproximal crater like defects
- May cause denudation (exposure) of and sequestration (separation of bone piece from surrounding bone tissue) of bone
What type of people is NUP most commonly found in?
- HIV
- Severe malnutrition/immunosuppression
