Acute Periodontal Disorders

Question 1

Gingivitis Types?

Answer 1

Non-specific
Gingival abscess
Trauma
Bac and viral
HIV associated
Fungal
Allergic

Question 2

Peridontitis Types?

Answer 2

Lateral periodontal abscess
Acute generalised
Traumatic periapical
Acute necrotising
HIV associated

Question 3

What does a gingival abscess involve?

Answer 3

Gingival tissue

Question 4

What causes acute herpetic gingivostomatitis?

Answer 4

Herpes simplex virus (type 1)

Question 5

Features of acute herpetic gingivostomatitis?

Answer 5

Affects children and young adults
Highly contagious and is spread from lesions with a 5-7 day incubation period
Many pts - infec is subclinical

Question 6

Symptoms of acute herpetic gingivostomatitis (AHG)?

Answer 6

More serious in adults
Sore, painful mouth
Loss of appetite
Numerous vesicles which soon rupture
Ulcers (grey membrane surrounded by bright red mucosa) = discrete or confluent
In young children = irritability and profuse salivation
Moderate or severe malaise, fever (flu-like symptoms)
Lymphadenopathy, stomatitis, pharyngitis

Question 7

Tx of AHG?

Answer 7

Supportive and symptomatic
Fluid intake/cold drinks/soft diet
Analgesics
Anti-pyretics
Topical antiseptics 5% lignociane M/W
Naturally self limiting 10-12 days
Highly infectious
Antivirals - acyclovir for severe cases

Question 8

Complications of AHG?

Answer 8

Herpetic whitlow in dentist or DST if not wearing gloves
Hereptic lesion in dentist eye if no goggles
Herpetic satellite lesions - if child sucks finger and scratches elsewhere
Herpetic encephalomeningitis
Not treat immunocompromised pts if you have a recurrent herpetic lesion

Question 9

How does the herpes virus reactivate?

Answer 9

Primary illness = infec of trigeminal ganglion
Subsequent reactivation can occur
Most commonly presents as herpes labialis (cold sore)
Intra-oral reactivation may occur after trauma (surgery/infil LA)
Occasionally a complication of perio surgery

Question 10

When does acute fungal gingivitis occur?

Answer 10

Acute candidal gingivitis due to superinfec with candida albicans
Often in pts with palatal dentures, pts recently finished a course of broad spectrum antibiotics therapy, debilitated pts

Question 11

When does acute allergic gingivitis occur?

Answer 11

1. Following systemic administration of drug or chemical

2. Following direct contract with mouth e.g. cosmetics, M/W

Question 12

Appearance of HIV associated gingivitis?

Answer 12

2 red lines along the gingivae

Question 13

Acute allergic gingivitis features?

Answer 13

Gingival tenderness may prevent effective cleaning
Mild symptoms to anaphylactic shock
Stop drug or cause if known

Question 14

Appearance of acute allergic gingivitis?

Answer 14

Red, shiny gingiva
Oedema
Loss of stippling

Question 15

Clinical features of NUG?

Answer 15

Localised or whole mouth (most common around lower incisors)
Gingivae sore and bleeding
Ulceration and necrosis of gingival margin, particularly dental papilla
Ulcers - grey/yellow slough and painful to touch
Often no systemic symptoms but lymphadenopathy common
Metallic taste, halitosis
Severe = bone and perio attachment loss
May be HIV associated

Question 16

Aetiology of NUG?

Answer 16

Opportunistic infec by anaerobes
Fuso-spirochaetal complex
Lowered resistance

Question 17

Predisposing factors of NUG?

Answer 17

Compromised immune, defence system e.g. HIV, leukaemia, malnutrition
Smoking
Stress
Poor OH

Question 18

Define a lateral periodontal abscess?

Answer 18

A collection of pus in the CT wall of a periodontal pocket

Question 19

Lateral periodontal abscess signs and symptoms?

Answer 19

Pain
Tissues around painful tooth = swollen, small localised enlargement to diffuse swelling
Tissue red or deep red-blue
Lymphadenopathy and fever
Affected tooth and adjacent = TTP
Tooth usually mobile and high in occlusion
Perio probing = deep pocket
Potential sinus tract draining the abscess

Question 20

Aetiology of lateral periodontal abscesses?

Answer 20

Deep perio pocket with active inflam and micro-ulceration
Entry of micro-organisms through pocket lining into CT = abscess
Blockage
Trauma
Reduction of host response

Question 21

How to make a differential diagnosis of lateral periodontal abscess?

Answer 21

History
Deep pocket
Vital tooth
Pus in pocket
Tooth may be extruded
Radiograph confirms bone loss

Question 22

How to make a differential diagnosis of periapical abscess?

Answer 22

History
Non-vital tooth
Tooth usually acute TTP
Pus in tissues
Tooth may be extruded
Radiograph may show apical change, cavity/restoration near pulp

Question 23

What influences the management of lateral periodontal abscesses?

Answer 23

Pt wishes
Pt medical condition
Prognosis for tooth
Prognosis for whole dentition

Question 24

Management of retaining the tooth with a lateral periodontal abscess?

Answer 24

Drain if fluctuant (topical or LA)
RSD if not fluctuant - aim for drainage through pocket
Selective grinding = relieves occlusion
Hot salt mouthwashes
Review

Antibiotics (if systemic involvement)
Amoxicillin 5 days with or without metronidazole
Azithromycin 3 days

Follow up - further assessment, scaling, plaque control, periodontal surgery (if appropriate)