emergencies

Question 1

symptoms that might lead pt to present

Answer 1

PAIN
swelling
pus
bleeding
mobility
ulceration

Question 2

abscesses types x4

Answer 2

periapical
gingival
periodontal
pericoronal

Question 3

differential diagnoses - irreversible pulpitis

Answer 3

poorly localised
constant, dull throbbing
unlikely to see anything radiographically - pulp not necrosed, no bone destruction

Question 4

differential diagnoses - reversible pulpitis

Answer 4

pain triggered by stimulus - hot/cold, not constant - resolves
as it gets more established triggered by sweet
unlikely to see anything radiographically - pulp not necrosed, no bone destruction
heightened response to sensibility testing

Question 5

differential diagnoses - periapical periodontitis

Answer 5

TTP
no response to sensibility testing (if caused by pulp necrosis extension)
pain to biting
might see bone loss radiographically (takes 3m to show)

Question 6

differential diagnoses - pericoronal abscess

Answer 6

PE tooth, usually L8s

Question 7

Periodontal abscess

Answer 7

a localised accumulation of pus within the gingival wall of a PD pocket resulting from the destruction of the collagen fibre attachment and the loss of nearby alveolar bone

active period of PD breakdown which occurs whilst there is marginal closure of the deep PD pocket occluding drainage

non-draining infection of a PD pocket

Question 8

PD abscess S + S

Answer 8

+ to sensibility testing
mobility
likely to see lat lesion on radiograph (but may not see anything)
pain and tenderness
swelling of gingiva
bleeding
deep pocket depth
may have suppuration

Question 9

PD abscess - what to do if tooth is unrestorable

Answer 9

extract

Question 10

SDCEP tx of a PD abscess

Answer 10

• subgingival instrumentation short of base of pocket to avoid iatrogenic damage, LA?
• if pus present - drain by incision or through the PD pocket
• recommend optimal analgesia
• don’t prescribe ABs unless signs of spreading infection or systemic involvement
• 0.2% CHX MW until acute symptoms subside
• review within 10 days and carry out definitive PD instrumentation and recall interval

Question 11

PD abscesses in non-periodontitis pts - possible cause

Answer 11

impaction of foreign bodies
harmful habits- nail biting
alteration of root surface e.g. perforation, root fracture etc

Question 12

what is ANUG now called?

Answer 12

necrotising gingivitis
necrotising periodontitis
- (chronically/severely compromised or temporarily/moderately compromised)
necrotising stomatitis

Question 13

NG presentation

Answer 13

acute onset of severe pain
marginal gingival ulceration and craters
punched-out appearance
loss of ID papilla
slough
rapidly destructive
necrosis locally
may have local lymphadenopathy/systemically unwell
halitosis
bleeding

Question 14

if NG not treated and controlled rapidly?

Answer 14

may leave significant gingival recession

Question 15

NG microbiology

Answer 15

anaerobic bacteria with fusiform and spirochetes species in a compromised host

Question 16

NG risk factors

Answer 16

neglected mouth - poor OH

smoking
stress
malnutrition
lack of sleep
prev NP
younger pts
immunosuppression/ immunocompromised
HIV infection

Question 17

NG tx SDCEP

Answer 17

• debridement - LA, ultrasonic
• MW until acute symptoms subside (0.2% CHX / 6% Hydrogen peroxide)
• review within 3-5 days and do definitive instrumentation as required, recall interval
• address risk factors - OH, smoking etc
• if no resolution, review general health and consider referral to specialist
• ABs if spreading infection/systemic involvement or local measures are incomplete at initial presentation
  
  • metronidazole 400mg x3 daily for 3 days

Question 18

secondary herpes

Answer 18

• often reactivated post-PD surgery esp palatally
• often not painful
• can be confused clinically with other bullous conditions and if uncertain refer to oral med
• self-limiting - 10 days
• analgesic , CHX MW
• if doesn’t resolve/recurrent refer to oral med

Question 19

chemical trauma e.g. from etch/bleaching agent

Answer 19

• acute onset, painful
• manage conservatively and prevent infection and tissue loss if possible
• irrigate lots
• reassure should heal in 2 weeks
• CHX MW and avoid brushing site until it heals
  
  • to prevent gingival recession

Question 20

primary herpetic gingivostomatitis spread and causative agent

Answer 20

• highly infectious, spread through contaminated saliva
• Herpes simplex virus HSV1
• usually in kids 2-5 yo

Question 21

primary herpetic gingivostomatitis S + S

Answer 21

acute onset usually but not always children
+/- systemic (potentially serious if present) - dehydration/encephalitis
painful ulceration preceded by fragile vesicles which are only rarely visible
affects gingival tissue, tongue, lips, cheeks and roof of mouth

Question 22

primary herpetic gingivostomatitis tx

Answer 22

• usually managed symptomatically as self-limiting over 5-7 days
• attention to fluid intake
• paracetamol
• reassurance
• consider aciclovir: shortens duration of symptoms, more rapid healing and helps to establish eating/drinking again earlier

Question 23

primary herpetic gingivostomatitis long term effect

Answer 23

may result in recurrent lesions at other sites, around 40% of individuals

Question 24

primary herpetic gingivostomatitis SDCEP tx

Answer 24

symptomatic relief: local measures
- avoid dehydration
- soft diet
- analgesics
- antimicrobial MW
if immunocompromised/severe infection
- aciclovir 200mg x5 daily for 5 days

Question 25

acute leukaemia

Answer 25

rare presenting as severe **hyperplastic gingivitis** hyperplastic tissue is full of leukaemic infiltrate acute or slower onset over a few weeks likely systemic S+S to aid diagnosis - **bone pain** - fever - freq infections - freq or severe **nosebleeds** - lymphadenopathy - **pallor** - **SOB** can also see **ulceration of inner surface of lip** due to acute neutropenic changes **urgent referral** via GMP/ oral med as soon as potential diagnosis is considered

Question 26

gingival abscess

Answer 26

* a localised purulent infection that involves the **marginal gingiva** or **ID papillae** * peridontally healthy

Question 27

gingival abscess S + S

Answer 27

localised swelling may have suppuration usually painful and TTP

Question 28

what is a gingival abscess often due to?

Answer 28

subgingivally impacted foreign objects, tend to occur in a prev healthy gingiva e.g. piece of nail due to a nail biting habit

Question 29

gingival abscess management

Answer 29

incise, drain and irrigate may need mechanical debridement to mitigate aetiology 0.2% CHX MW/saline rinse review

Question 30

SDCEP periodontitis associated with endo lesions - definition

Answer 30

clinical AL and also a tooth with necrotic/partially necrotic pulp

Question 31

perio endo lesions S+S

Answer 31

swelling **suppuration** TTP may have generalised **PDD** with localised pain **deep pocketing** to root apex with BOP negative response to sensibility tests

Question 32

SDCEP perio endo lesion tx

Answer 32

**endo** tx of tooth (get drainage?) recommend optimal **analgesia** no ABs unless signs of spreading infection or systemic involvement **0.2% CHX MW** until acute symptoms subside review within 10 days and **PD instrumentation**, recall

Question 33

perio endo lesion

Answer 33

* **communication** between PD lesion and pulp * **deep pocket** around a **non-vital tooth** origin * the infection may arise **primarily from pulpal inflammatory** disease expressed through the PDL or the alveolar bone to the oral cavity, * or it may be **initiated from a PD pocket** communicating to the pulp **apically** or through **accessory canals**

Question 34

prognosis of primary endo lesions

Answer 34

often respond well to RCT alone

Question 35

prognosis of primary perio/truly combined lesions

Answer 35

often poor

Question 36

prognosis of endo perio lesions associated with trauma and iatrogenic factors e.g. perforation

Answer 36

usually poor as affect tooth structure