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Periodontics > Acute Periodontal Lesions and Mucogingival conditions > Flashcards

Acute Periodontal Lesions and Mucogingival conditions Flashcards

1
Q

Acute
Periodontal
Lesions
(3)

A

*Periodontal Abscesses
*Necrotizing periodontal
diseases
*Endo Perio lesions

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2
Q

Frequent
Dental
Emergency
A. –% of all emergency
patients, 3rd most common
B. –% of untreated
periodontal patients
C. –% of patients in
active periodontal treatment
D. –% of patients in
periodontal maintenance

A

7‐14
60
13.5
37

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3
Q

Periodontal Abscess

A

Localized accumulation
of pus located within the
gingival wall of the
periodontal pocket, with
an expressed periodontal
breakdown occurring
during a limited period of
time, and with easily
detectable clinical
symptoms.

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4
Q

Periodontal Abscess
Etiology
(6)

A

Pulp necrosis,
Periodontal infections
Pericoronitis
Trauma
Surgery
Foreign body impaction

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5
Q

Sequence of events leading to
abscess formation:
(8)

A
  1. Occlusion of existing periodontal
    pocket.
  2. Bacterial invasion of soft tissue
    wall.
  3. Leukocytic infiltration (neutrophils).
  4. Vascular thrombosis.
    *5. Edema and swelling.
    *6. Tissue necrosis & liquefaction.
    *7. Collagenolysis & bone resorption.
    *8. Production of purulent exudate.
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6
Q

Acute Periodontal Disease
*Most common symptoms in order of decreasing frequency:
(4)

A

*1. Pain
*2. Swelling and Edema
*3. Lymphadenopathy
*4. Fever

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7
Q

Periodontal Abscess
*Multiple abscess formation is often a manifestation of:
(3)

A

*Diabetes (Uncontrolled or undiagnosed): most of the
cases have this as a cause.
*AIDS (compromised immune system)
*Depressed Immune System (steroid therapy,
chemotherapy)

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8
Q

Microbiology

A
  • 65% of the microbial flora is
    Gram‐Negative and anaerobic.
  • Bacteria that produce
    proteinases, as P. gingivalis and
    P. intermedia are important in
    the pathogeneses of the
    periodontal abscess since they
    increase the availability of
    nutrients, and thereby increase
    the number of bacteria within
    the abscess environment.

*Treponema (spirochetes)
*Fusobacterium nucleatum
*Prevotella intermedia
*Porphyromonas gingivalis
*Peptostreptococcus micros
*Tannerella forysthia
*Candida albicans

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9
Q

Histopathology of Abscess
(5)

A

Acute inflammatory infiltrate
Vascular hyperemia and thrombosis
Lysis of the collagen matrix in the lamina propria and the gingival fibers
Ulceration and apical proliferation of JE
Osteoclastic mediated bone resorption

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10
Q

Periodontal Abscess in periodontitis patients
(3)

A

*Periodontal abscess could represent a period of disease exacerbation( due
to the presence of a tortuous pocket, furcation involvement, or vertical
defect)
*Composition of microflora
*Decreased host defense

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11
Q

Periodontal Abscess in periodontitis patients
Acute Exacerbation:
(3)

A

*In untreated periodontitis
*Non‐responsive to
periodontal therapy
*Patients on supportive
periodontal therapy

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12
Q

Periodontal Abscess in periodontitis patients
After treatment
(3)

A

*Post‐Scaling
*Post‐surgery
*Post‐medication
 Antimicrobials
 Nifedepine

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13
Q

Periodontal abscess in non periodontitis
patients
(5)

A

*Impaction of foreign bodies
*Harmful habits
*Orthodontic factors
*Gingival enlargement
*Alteration of the root surface including

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14
Q

*Alteration of the root surface including
(5)

A

 Dens invaginatus
 cemental tears or enamel pearls
 Iatrogenic conditions such as perforations
 Severe root damage: Vertical root fracture or
cracked tooth syndrome
 External root resorption

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15
Q

Periodontal Abscess
(Clinical Signs)
(10)

A
  1. Pain
  2. Localized swelling and fluctuence
  3. Purulent exudate
  4. Deep periodontal pocket
  5. Tooth exhibits vital pulp
  6. May present with a fistula
  7. Tooth mobility
  8. Sensitivity to percussion
  9. Low grade fever
  10. Lymphadenopathy
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16
Q

Periodontal Abscess
(Differential Diagnosis)
(6)

A

1.
Periapical
abscess
2. Acute
pulpitis
3. Tooth
or root fracture
4.
Pericoronitis
5. Lateral
periodontal cyst
6.
Gingival cyst

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17
Q

Abscess
Complications
(3)

A

Tooth loss (up to 45% of teeth with
periodontal abscesses in maintenance
are extracted)
Bacteremia following abscess
treatment
Chronic or episodic bacteremia from
untreated periodontal disease

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18
Q

Abscess
Treatment
(5)

A

Non‐surgical drainage and debridement
with local anesthetic
Surgical Drainage for large abscess
Surgical Therapy with flap reflection,
debridement with ultrasonic, sutures
Antibiotics if systemic infection indicated
by fever or lymphadenopathy
Reevaluation and any further needed
therapy

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19
Q

*Diagnosis
(5)

A

*Health history and medications
*Dental history
*Current periodontal status
*Current status of affected tooth
*Periapical radiographs

20
Q

Health history and medications
(2)

A

*Diabetes
*Systemic antibiotics

21
Q

Current status of affected tooth
(2)

A

*Cold and EPT tests vital
*Pain on percussion

22
Q

Clinical exam
(4)

A

*Redness
*Swelling
*Purulent discharge
*Lymphadenopathy

23
Q

Determine etiology
(6)

A

*Calculus fragments from recent cleaning
*Systemic antibiotic treatment without subgingival debridement
*Acute exacerbation of untreated periodontitis
*Foreign body impaction
*Endodontic perforation
*Cemental tear

24
Q

Treatment
*Closed approach
(2)

A

*Incision and drainage through the pocket
*Root planning to depth of sulcus

25
Q

Treatment
*Open approach
(3)

A

*Sulcular incisions and full thickness flap
*Remove all visible soft and hard deposits from root and adjacent bone
*Replace flap and suture closed

26
Q

Treatment
*Thorough —
*Consider —

A

irrigation
systemic antibiotics (usually not needed)

27
Q

Postoperative Therapy
(4)

A

*Home care
*Prescribe analgesics
*Re‐evaluation
*Frequently monitor radiographically and clinically at maintenance appointments for evidence of periodontal disease.

28
Q

Acute
Periodontal
Diseases
(4)

A

Acute Pericoronitis
Acute Herpetic Gingivostomatitis
(Acute) Periodontal Abscess
(Acute) Necrotizing Ulcerative Gingivitis

29
Q

Role of Keratinized Gingiva
Highly debated over many years
Possible to maintain periodontal health in the absence of keratinized gingiva.
All surfaces with less then — mm of keratinized gingiva exhibit clinical inflammation even in the absence of plaque.
When a narrow band of keratinized gingiva is present, sites with a — phenotype has a greater tendency to progress

A

2.0
thinner

30
Q

Keratinized gingiva
*How much is enough?
*Bowers 63: normal varies from —
*Lang and Loe 72: need — keratinized, 1mm attached
*Maynard and Wilson 79: — keratinized needed for restorative with — attached
*Dorfman and Kennedy 80: less than 1 mm is adequate if inflammation is controlled
*Freedman et al 99: 18 year study, less than — is adequate if inflammation is controlled

A

1‐9mm
2 mm
5mm
3 mm
1 mm

31
Q

Periodontal Phenotype
*Based on Anatomic characteristics
(3)

A

A. Gingival Phenotype
Keratinized tissue width ‐Avg 5.72 mm for thick biotype and 4.15 mm for thin phenotype
Gingival Thickness‐ranged from 0.63mm‐1.24 mm.
B. Bone Morphotype ( BM) – mean 0.34 mm for thin biotype and 0.754 for thick/Avg phenotype
C. Tooth Position

32
Q

Gingival recession by definition is

A

apical migration of the gingival margin with concomitant exposure of the root surface.

33
Q

Gingival recession by definition is apical migration of the gingival margin with concomitant exposure of the root surface.
This condition affects

A

a large population irrespective of Oral Hygiene.

34
Q

Gingival Recession
*Estimated prevalence:
*—% of young adults
*—% Middle aged‐Elderly adults suffer from Gingival recessions with an average prevalence of —%

A

54.5
100, 78.6

35
Q

Gingival Excess
(4)

A

Pseudo pocket
Inconsistent gingival margin
Excessive gingival display
Gingival enlargement

36
Q

Changes in Color

A

Normal.
Physiologic pigmentation
Subtle changes in color,
contour and consistency

37
Q

CEJ STEP DESCRIPTORS
Class A
Class A
Class B
Class B

A

‐ CEJ detectable without step
+ CEJ detectable with step
‐ CEJ undetectable without step
+ CEJ undetectable with step

38
Q

Most common mucogingival
defects in Daily practice
(2)

A
  1. Gingival Recessions
  2. Inadequate Zone of keratinized gingiva
39
Q

Predisposing Factors:
(5)

A

*1. Periodontal Biotype and
attached Gingiva
*2. The impact of tooth brushing
*3. The impact of cervical
restorative margins
*4. The impact of orthodontics
*5. Other conditions

40
Q

Diagnostic
considerations
(3)

A

*Recession Depth and Gingival thickness.
*Modern Recession classification ( CAIRO et al 2011)

41
Q

*Recession Type (RT) 1

A

‐Gingival Recession with No loss of interproximal attachment. Interproximal CEJ was not detected either on the mesial or distal aspect of the tooth.

42
Q

Recession Type (RT) 2

A

‐ Gingival recession associated with loss
of interproximal attachment. The amount of interproximal
attachment loss was less or equal to the buccal attachment
loss.

43
Q

Recession Type (RT) 3‐

A

Gingival recession with the loss of interproximal
attachment. Interproximal attachment loss is greater than the buccal
attachment loss.

44
Q

Cairo Classification for
gingival recession
Treatment oriented
RT 1 ( Miller Class I and II) :
Cairo RT 2 ( overlapping Miller Class III):
Mixed results
Cairo RT 3 (Overlapping Miller Class IV):

A

100% root coverage can be predicated
Mixed results
Full root coverage is not achievable

45
Q

Comparison on treated and untreated sites

A

*18‐35 year follow‐up
*47 patients with 64 sites
*83% of the 64 treated sites showed recession reduction, while 48% of
the 64 untreated sites experienced increased recession
*Number of increases in recession was limited
*Thin gingival biotypes augmented by grafting remained stable over
time compared to untreated areas with thin biotypes.
*Untreated areas also showed a tendency to develop new recession.

Periodontics (13 decks)

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