Perio test 1 - Diseases/treatments

Question 1

Systemic conditions with ANUG sequelae (7)

Answer 1

1&2)Nutrition and stress
3)Poor oral hygiene
4&5)Fever and Lymphadenopathy
6)Smoking
7)AIDS

Question 2

1 standout Effect

Gingival Effects of ANUG

Acute (3)

Chronic (1)

Answer 2

*punched out papilla

Acute

• Stench
• PAIN
• Bleeding

Chronic: patients may have a background of previous CHRONIC Periodontitis

Question 3

Do papilla that are lost during ANUG regenerate?

Answer 3

Usually NO.

-There is often a mucogingival defect that may be fixed with a Gingival Graft or other surgery.

Question 4

Can ANUG be found extragingivally?

Answer 4

Yes.
-Palate and other soft tissue

it is RARE however.

Question 5

Ignoring the complexity of a case, what is the most ideal treatment for the patient and their own long-term care with ANUG?

Answer 5

Giving the patient oral hygiene instruction, including a PROXY Brush.

-It may be VERY painful for the patient, but it can show the patient that this very UNPLEASANT disease can be controlled BY THE PATIENT with diligent home care!

Question 6

Take home treatments for patient with ANUG (3)

Answer 6

Proxy brush and oral hygiene

Antimicrobial rinses
-H2O2 and Chlorhexidine Rinses

Antibiotics (for systemic conditions)
-ONLY if patient presents with fever OR Lymphadenopathy.

Question 7

Antibiotics for ANUG (3)

Answer 7

Amoxicillin, Erythromycin and Metronidazole

Question 8

What Anatomic reasoning is there for ANUG presenting with Punched out Papilla?

Answer 8

The disease effects: constriction of blood vessels that are IN nearby Gingival tissue, and because the papilla contain TERMINAL Blood Vessels in the oral circulation, there is necrosis.

Question 9

Why is Root planing used in the treatment of ANUG.

Answer 9

It isn’t. Boom

Question 10

What treatments may be done in the clinic for ANUG? (2)

Answer 10

Topical anesthetic.

• Gentle Debridement ->Removing necrotic tissue
• Cotton Pellet and ultrasonic SCALERS.

Question 11

What is the initial action taken by clinician in a clinical setting for ANUG?

Answer 11

1 – Get patient out of pain (Topical anesthetic?)

Question 12

How long after initial visit of a patient with ANUG would further treatment be planned?

Answer 12

> 4 Weeks - At least a month.

Question 13

What types of treatment AFTER the initial visit of patient with ANUG may be performed?

-Why is this treatment done?

Answer 13

Surgical correction of gingival contours.

WHY?-It will restore aesthetics and increase patients ability for oral hygiene in areas effected.

Question 14

What is Pericoronitis?

Answer 14

Pericoronitis (from the Greek peri, “around”, Latin corona “crown” and -itis, “inflammation”) also known as operculitis, is inflammation of the soft tissues surrounding the crown of a partially erupted tooth.

Question 15

Step 1 in case of Pericoronitis?

-Evaluate disease FOR (2):

Answer 15

Evaluate disease FOR:

1) Severity of pain and inflammation

2) Systemic complications
* Fever / Lymphadenopathy

Question 16

Treatments for Pericoronitis? (4)

Answer 16

1-Irrigation AND
2-Debridement (possibly with local or topical anesthetic)

3- Surgical removal of flap AND/OR
4- Removal of Tooth

Question 17

Why is removal of the flap of pericoronitis not sufficient treatment?

Answer 17

Leaving behind a Pseudo-pocket!

Question 18

Complications of Pericoronitis beyond initial presenting symptoms of inflammation and pain?

Answer 18

Pseudo-pocket.

-Deep tissues holding: Bacteria and impacted food

Question 19

Healing of Pericoronitis? (2)

Answer 19

Replacement of lost Gingiva with gingiva-like fibrous tissue.

-painless

Question 20

2 types of Gingivostomatitis

Answer 20

Primary and Recurrent.

Question 21

Primary (4) vs Recurrent (4)!

Answer 21

Primary

• Children
• Fever
• Full mouth affected
• Painfully sore MOUTH (entire)

Recurrent

• Adults
• Fever
• Only parts of mouth innervated by affected ganglion
• ——Released by stress or activation of ganglion by Prophy, etc.
• 7-10 Day course!

Question 22

Palliative treatment for Acute Herpetic Gingivostomatitis (AHG) (4)

Answer 22

1) Topical anesthetic
2) Fluid intake ^^
3) Aspirin - NOT for children (risk of Rye’s Syndrome)
4) Antibiotics for systemic complications ONLY

Question 23

Medication for AHG (NOT antibiotics nor aspirin)?

- Time frame required for effectiveness of this Medication.

Answer 23

AntiVIRAL - Acyclovir (15mg/Kg) x 5 timesAday x 7 days

-must catch within 4 days or less for effectiveness.

Question 24

Common Differential for AHG.

-Differential diagnosis points (2)

Answer 24

Consistent with the vesicle–>Ulcers of Desquamative Gingivitis!

-Can be differentiated by 1) History of Desquamation and 2) weakness of all gingiva: Sloughing of gingival tissue.

Question 25

Another AHG differential (NO sloughing of gingiva) | -point of differential

Answer 25

Aphthous ulcers | -Aphthous ulcers will appear on Mucosa! not gingiva

Question 26

Common sequelae for Pericoronitis!

Answer 26

Acute! Periodontal abscess

Question 27

Symptoms of Acute Periodontal Abscess (PD abscess) (4)

Answer 27

1) Periodontitis specific bacteria 2) Deep pocket 3) Swelling 4) Pain

Question 28

Treatment of Acute PD Abscess (3)

Answer 28

1) Local anesthetic 2) Gentle debridement -->WITH small scaler ??? CURET? 3) Drainage*

Question 29

Types of drainage for Acute PD Abscess (2)

Answer 29

Drainage through pocket External drainage

Question 30

"Drainage through pocket" PD abscess: step(s)

Answer 30

Usually place probe into possible pocket and there will be a release of puss and 90% chance of ALSO blood.

Question 31

When is Root Planing done on acute PD abscess?

Answer 31

Not during initial treatment. During follow up appointment.

Question 32

Follow up appointment for acute PD abscess? (3)

Answer 32

- Analgesics - Antibiotics - *Definitive PD therapy (Phase I) - scaling and root planing to REDUCE pocket depth and likeliness of recurrence.

Question 33

Differential for acute PD abscess (3)

Answer 33

1) Pyogenic granuloma (only if pregnant and a woman...) 2) Malignancy (check for firmness and puss) 3) Acute Endodontic Abscess (NON-VITAL)

Question 34

Gingival Abscess - Found: - Common Cause:

Answer 34

Gingival abscess: - Found in Marginal Gingiva ONLY - Commonly caused by: Foreign object

Question 35

Treatment of Gingival Abscess (3-4)

Answer 35

1) Local Anesthetic 2) Debridement 3) Incision (if needed) [4) Follow up]

Question 36

``` All of these 5 diseases: ANUG -Pericoronitis -AHG -Acute PD Abscess -Gingival abscess ``` All are considered:

Answer 36

Local Diseases!

Question 37

Fetor Oris is seen in

Answer 37

ANUG

Question 38

Fast recognition and treatment of AHG includes what medication (& dosing) ? -*What phase of the viral infection is this treatment utilized **How can this early treatment be utilized?

Answer 38

Acyclovir 15mg/Kg x 5 times a day x 7days PRODROMAL Stage of Viral infection **Patients can often feel the AHG "coming on" with repeated aggravations.