Acute Periodontal Conditions Flashcards
(24 cards)
What are the 3 main acute periodontal conditions?
1) Abscesses
2) Necrotising periodontal diseases
3) Viral infection: herpetic gingivostomatitis
What are the main types of abscesses?
2 main types:
1) periapical
2) periodontal
- gingival abscess
- pericoronal
- periodontal
- combined endo-perio or perio-endo lesions
What is an abscess?
Localised collection of pus which forms during an acute infection
What is a periapical abscess?
localised infection at the apex (tip) of the root of a tooth
Which is the most common type of abscess?
periapical abscess
What is the cause of a periapical abscess?
bacteria that has spread to the pulp of the tooth and has caused necrosis. The infection has then spread outwards via the canals and has entered the surrounding tissue
-Bacteria can enter from dental caries, injury, failed dental treatment (root canal)
What type of teeth (vital/non-vital) are assocaited with periapical abscesses?
non-vital teeth. The pulp is often undergoing necrosis
What are the clinical features of periapical abscess?
- acute pain
- tender to percussion
- slight elevation of tooth
- swelling of surrounding tissues
- may see parulis (white pastule) along gingival surface
What is a periodontal abscess?
localised infection within the periodontal tissues surrounding/lateral to a tooth
What is the cause of a periodontal abscess?
- Infection is caused by bacteria within periodontal pocket. -Often the result of untreated periodontal disease and associated with deep pockets.
- May be caused by incomplete calculus removal, deposits left within pocket.
- May be caused by trauma (fishbone, toothbrush bristle) this can inoculate bacteria into periodontal tissue
What type of teeth (vital/non-vital) are associated with periodontal abscesses?
vital teeth
What are the clinical features of a periodontal abscess?
- pain (deep and throbbing), often when biting on tooth
- tooth may be mobile (infection may have spread to periodontal ligament and surrounding bone tissue)
- often has deep pockets
- not really carious
- suppuration via the pocket
What are the main steps for treatment of a dental abscess?
1) pain management and drainage
2) maintain drainage
3) remove cause of infection
What is the process in managing a dental abscess in the clinical setting? What would you investigate before carrying out treatment?
1) Assess extra-orally (swelling of lymph nodes, face, asymmetry, sinus draingage, trismus)
2) Assess intra-orally (erythema, oedema or tissue, suppuration from sinus/pocket, accessibilty, site of infection, tooth is TTP,
3) Radiographs
- Periapical or vertical bitewings: marginal bone loss and apical aspect
- A gutta percha point
- Widening periodontal ligament
- vertical fractures
4)Pulp vitality test
electric/ thermal
5)Microbiological culture/sensitivity
How would you carry out treatment on a dental abscess?
1) Drain tooth
- Identify site of drainage/sinus
- Administer LA if possible, not at site of infection
- using curette/probe lift pocket wall
- using fingers gently push from apex to pocket opening to allow drainage
- flush with Cavitron
- if possible use Curettes to remove deposits/subgingival
- If not possible to drain through pocket a dentist will be required to make incision and drain via sinus
What antibiotics can you give for abscess?
Amoxicillin:500mg 3X daily for 5 days AND/OR
Metronidazole: 400mg 3X daily for 5 days. (Contraindicated in pregnant patients, alcohol dependency, Warfarin users)
The dose is dependant on type of infection and risk it poses to patient
What does a periapical abscess look like on a radiograph?
Radiolucency at apex (root tip) of tooth
What does a periodontal abscess look like on a radiograph?
Radiolucency lateral to tooth, can see widening of periodontal ligament (black line)
What is necrotising ulcerative gingivitis NUG?
What tissues are affected?
- It is a distinct & specific form of periodontal disease.
- It has an acute clinical presentation involving the destruction and inflammation of the gingival tissues
What is the clinical appearance of NUG?
What are the symptoms?
Clinical features:
- gingival necrosis and ulceration of the tips of interdental papilla and gingival margins. Results in ‘punched out’ appearance
- pseudomembrane formation (yellow-white slough covering ulcers)
- gingival bleeding
- pronounced halitotis
- deep pockets not evident
- rapid rate of bone destruction
symptoms:
- metallic taste
- severe, deep aching pain
- lymphadentitis (swollen lymph nodes)
- fever
What is the treatment for NUG?
Acute phase: eliminate acute inflammation, reduce pain
- irrigate and debride necrotic tissue with ultrasonic as much as the condition allows
- personal home care plan: careful toothbrushing with gentle brush, mouthwashes (0.12% chlorhexidine 2X daily for 10 days),
-systemic antibiotics
Metronidazole: 200-400mg, 3X daily for up to 3 days
contraindicated in pregnancy, alcohol dependancy, drug interactions with Warfarin. Instead: Amoxicillin
Penicillin V: 250mg 4X daily for up to 5 days
what is primary herptic gingivostomatitis? (PHGS)
acute manifestation of the Herpes Simplex Virus I
Who is the most common patient to get herpetic gingivostomatitis?
preschool children
it can affect adults
if it occurs in babies, often mistaken for teething
what are the clinical features of primary herpetic gingivostmatitis?
- characterised by a prodrome (early symptom signalling onset of disease)
- small vesicles throughout oral mucosa, tongue and gingivae. Vesicles rupture leading to ulceration which will coalesce into a fibrinous coating -> gingivostomatitis
-gingival margins have erythema and oedema
