Acute periodontal disorders

Question 1

Acute gingivitis

Answer 1

 Non-specific
 Gingival abscess
 Traumatic (physical,
chemical, thermal)
 Bacterial and viral
 HIV associated
 Fungal(rare)
 Allergic

Question 2

Acute periodontitis

Answer 2

 Lateral periodontal
abscess
 Acute generalised
 Traumatic periapical
 Acute necrotising
 HIV associated

Question 3

Plaque related gingivitis

Answer 3

Gums bleed
Remove plaque
Within a fortnight it goes away

Question 4

Traumatic gingivitis

Answer 4

Physical trauma e.g. toothbrush
Thermal trauma e.g. hot cheese on pizza
Chemical trauma e.g. aspirin on gums

Question 5

Gingival abscess

Answer 5

Only involves gingival tissue i.e. does not involve periodontal membrane
Pocket-full of pus caused by pus within gingival tissue e.g. nail stuck in gingiva

Question 6

Herpes

Answer 6

Primary herpes infection
Often in children but not always
Causes very red gingivae
Child is very upset, clingy, mouth hurts
Provide cold fluid e.g. ice cream helps sooth pain
Self-limiting so don’t need to prescribe anything else
Systemic complications - refer or prescribe acyclovir

Question 7

Acute herpetic gingivostomatitis

Answer 7

 Caused by herpes simplex virus (Type 1)
 Affects children and young adults
 Highly contagious and is spread from
lesions with a 5-7 day incubation period
 In many patients the infection is
subclinical

Question 8

Symptoms of AHG

Answer 8

 More serious in adults
 Sore, painful mouth
 Loss of appetite
 Numerous vesicles which soon rupture
 Ulcers (gray membrane surrounded by bright
red mucosa) may be discrete or confluent
 In young children irritability and profuse
salivation
 Moderate or severe malaise, raised
temperature: Flu-like symptoms
 Lymphadenopathy, stomatitis, pharyngitis
 Should be easy to distinguish from ANUG,
though these conditions have been known to
occur simultaneously

Question 9

Treatment of AHG

Answer 9

 Mainly supportive and symptomatic
 Fluid intake/cold drinks/soft diet
 Analgesics
 Anti-pyretics
 Topical antiseptics 5% lignocaine mouthwash
 Naturally self-limiting 10 – 12 days
 Highly infectious – avoid contact with others
 Antivirals e.g. acyclovir should be reserved for
severe cases

Question 10

Complications of AHG

Answer 10

 Herpetic whitlow in dentist or DSA if not
wearing gloves
 Herpetic lesion of eye in dentist or DSA if
not wearing goggles
 Herpetic satellite lesions eg. caused if child
sucks finger and scratches elsewhere
 Herpetic encephalomeningitis
 You should not treat patients that are
immunocompromised if you have a
recurrent herpetic lesion

Question 11

Reactivation of virus

Answer 11

 Primary illness leads to infection of trigeminal
ganglion
 Subsequent reactivation can occur
 Most commonly presents as herpes labialis (cold
sore)
 Intra-oral reactivation may occur following
trauma such as surgery or even infiltration
anaesthesia
 Occasionally a complication of periodontal
surgery

Question 12

HIV associated gingivitis

Answer 12

Two red lines all along the gum

Shouldn’t see it much anymore

Question 13

Acute fungal gingivitis

Answer 13

 Acute candidal gingivitis can occur due to
superinfection with candida albicans
 Often seen in pts who wear partial
dentures
 Seen in those that have recently finished a
course of broad spectrum antibiotic
therapy
 Also seen in debilitated patients
-can rub candida off, would be left with red inflammation underneath

Question 14

Acute allergic gingivitis

Answer 14

 Adverse reactions - 2 types
1. Following systemic administration of drug
or chemical
2. Following direct contact with mouth
e.g. cosmetics, mouthwashes

Question 15

Acute allergic gingivitis signs

Answer 15

Red, shiny gingiva
Oedema
Loss of stippling

Question 16

Acute allergic gingivitis symptoms

Answer 16

 Gingival tenderness may prevent effective
cleaning
 Range of symptoms from mild to anaphylactic
shock

Question 17

Acute allergic gingivitis treatment

Answer 17

 Stop drug or cause if known

Question 18

Traumatic acute periodontal disorders

Answer 18

Associated with root fracture UL1
Traumatic periapical
Swelling

Question 19

Acute necrotising perio disorders

Answer 19

Could be due to stress
Changes in bacterial flora
Ulceration, pain, halitosis, necrosis

Question 20

Clinical features of NUG

Answer 20

 Localised or whole mouth (localised most often seen
around lower anteriors)
 Gingivae sore and bleeding
 Ulceration and necrosis of gingival margin, particularly
dental papilla (punched out)
 Ulcers covered in grey/yellow slough and painful to
touch
 Often no systemic symptoms but lymphadenopathy,
often present
 Metallic taste, halitosis
 If severe, bone and periodontal attachment can be lost
 May be associated with HIV

Question 21

Aetiology of NUG

Answer 21

 Opportunistic infection by anaerobes
 Fuso-spirochaetal complex (eg. Treponema
vincentii, Fusobacterium nucleatum
 No evidence condition is transmissable
 Lowered resistance

Question 22

Predisposing factors to NUG

Answer 22

 Compromised immune, defence system eg.
HIV, leukemia, malnutrition
 Smoking
 Stress
 Poor oral hygiene

Question 23

NUG or NUP

Answer 23

Dependent on if it affects/ involves periodontium or not

Question 24

HIV associated periodontal disorder

Answer 24

Tends to be more destructive

Question 25

Lateral periodontal abscess definition

Answer 25

A lateral periodontal abscess is a collection of pus in the connective tissue wall of a periodontal pocket

Question 26

Presenting signs and symptoms of lateral periodontal abscess

Answer 26

 Pain, most common presenting symptom  The tissues surrounding the painful tooth or teeth are usually swollen, small localised enlargement to diffuse swelling  The tissues often appear to be red or a deep red-blue in colour  Lymphadenopathy and fever may be present  The affected tooth, and often the adjacent teeth, are usually tender to bite on and TTP  The tooth is usually mobile and high in the occlusion.  Periodontal probing usually reveals the presence of a deep pocket  There may also be evidence of a sinus tract draining the abscess

Question 27

Lateral periodontal abscess aetiology

Answer 27

```  A deep periodontal pocket with active inflammation and micro-ulceration  Entry of micro-organisms through pocket lining into connective tissue produces abscess  Blockage  Trauma  Reduction of host response ```

Question 28

Differential diagnosis of lateral periodontal abscess

Answer 28

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

Question 29

Differential diagnosis of periapical abscess

Answer 29

```  History  Tooth non-vital (may be discoloured)  Tooth usually acute TTP  Pus in the tissues  Tooth may be extruded  Radiograph may show apical change  Radiograph may show cavity/restoration near pulp ```

Question 30

Management of lateral periodontal abscess

Answer 30

``` Extract or retain influenced by:  Patient’s wishes  Patient’s medical condition  Prognosis for the tooth  Prognosis for the dentition as a whole ```

Question 31

Management of lateral periodontal abscess: retaining the tooth

Answer 31

``` Acute phase:  Drain if fluctuant (topical or local anaesthetic)  Root surface debridement if not fluctuant; aim for drainage through the pocket.  Selective grinding to relieve occlusion if appropriate  Hot salt mouthwashes  Review  Antibiotics, only if systemic involvement  Amoxicillin 5days with or without Metronidazole,  Azithromycin 3 days Follow up:  Further assessment  Scaling  Plaque control  Periodontal surgery , if appropriate ```