Periodontal/endo lesions and periodontal abscess

Question 1

what are types of Abscesses of the Periodontium?

Answer 1

o Gingival abscess. Localised to gingival margin
o Periodontal abscess:
o Pericoronal abscess:
o Endodontic-Periodontal Lesion:

Question 2

what is periodontal abscess?

Answer 2

• usually related to preexisting deep pocket
• also associated with food packing
• and tightening of gingival margin post HPT
• Rapid destruction of periodontal tissues, with a negative effect on the prognosis of the affected tooth

Question 3

what is pericoronal abscess?

Answer 3

associated with partially erupted tooth most commonly 8s

Question 4

what is endodontic-periodontal lesion?

Answer 4

• communication between the endodontic and periodontal tissues of a given tooth

Question 5

what are signs and symptoms of abscess?

Answer 5

o Swelling
o Pain
o Tooth may be TTP in lateral direction
o Deep periodontal pocket
o Bleeding
o Suppuration
o Enlarged regional lymphnodes
o Fever
o Tooth usually vital
o Commonly pre-existing periodontal disease

Question 6

what do you do if puss is present in a periodontal abscess?

Answer 6

drain by incision or through the periodontal pocket.

Question 7

what do the SDCEP guidelines tell you about how to treat abscess?

Answer 7

• sub gingival instrumentation short of base of pocket. Avoids iatrogenic damage.
• pus present = drain by incision or through pocket
• recommed analgesia
• no antibiotic unless infection or systemic involevement
• give 0.2% chlorohexidine MW until stop acute symptoms
• follow acute management, review and carry out perio instrumentation

Question 8

you do not prescribe antibiotics until there are signs of what in relation to an abscess?

Answer 8

Do not prescribe antibiotics unless there are signs of spreading infection or systemic involvement.

Question 9

what do you recommend the use of until the acute symptoms of an abscess subside?

Answer 9

Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.

Question 10

what are the systemic antiobiotics treatment you give for periodontal abscess?

Answer 10

 Only if signs of spread and systemic effects or if symptoms do not resolve with local measures
 Careful RSD
 Penicillin V 250mg(preferred) or Amoxicillin 500mg 5 days
 Or
 Metronidazole 400mg 5 days

Question 11

what is acute endo periodontal lesion”

Answer 11

o Trauma
o Perforation

Question 12

what is chronic endo periodontal lesion?

Answer 12

o Pre-existing periodontitis
o Slow and chronic progression without evident symptoms

Question 13

what are the signs and symptoms of an endo periodontal lesion?

Answer 13

o deep periodontal pockets reaching or close to the apex
o pulp vitality = negative
o bone resorption @ apical or furcation region
o spontaneous pain
o Pain on palpation and percussion
o pus
o tooth mobility
o sinus tract
o crown, and gingival colour alterations

Question 14

what is main route of communication between pulp and periodontium?

Answer 14

apical foramen

Question 15

what is apical foramen role in communicating between pulp and periodontium?

Answer 15

• periradicular pathoses = Microbial and inflammatory by-products may exit the apical foramen
• apex- portal of entry - for inflammatory by-products from deep periodontal pockets to affect the pulp.

Question 16

what does perforation result in?

Answer 16

Results in communication between the root-canal system and either peri-radicular tissues, periodontal ligament or the oral cavity.

Question 17

what are causes of perforation?

Answer 17

 extensive dental caries
 resorption
 operator error e.g. root-canal instrumentation or post preparation

Question 18

what are the Endo‐periodontal lesions associated with trauma and iatrogenic factors?

Answer 18

o root/pulp chamber furcation perforation
o root fracture or cracking
o external root resorption
o pulp necrosis draining through the periodontium

Question 19

what is treatment of perio-endo lesions?

Answer 19

 Carry out endodontic treatment of the affected tooth.
 Recommend optimal analgesia.
 Do not prescribe antibiotics unless there are signs of spreading infection or systemic involvement.
 Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.
 Following acute management of the lesion, review within ten days and carry out supra- and sub-gingival instrumentation if necessary and arrange an appropriate recall interval

Question 20

endo infection in mandibular molars was associated with more attachment loss in what area?

Answer 20

furcal area

Question 21

how does endo infection in molars associated with periodontal disease enhance periodontitis progression?

Answer 21

by spreading pathogens through accessory canals and dentinal tubules

Question 22

Does periodontal disease affect endodontics

Answer 22

 no effect on the pulp, at least until it involves the apex
 Periodontal disease on the pulp is degenerative and causes calcification, fibrosis and collagen resorption, as well as a direct inflammatory affect

Question 23

Pulp is usually not significantly affected by periodontal disease until when?

Answer 23

until recession affects a lateral or accessory canal to the mouth.

Question 24

what is Function of the periodontium?

Answer 24

o To attach the teeth to the jaws
o To dissipate occlusal forces

Question 25

what is effective occlusal force?

Answer 25

- occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus, - results in occlusal trauma and/or causes excessive tooth wear (loss).

Question 26

what does occlusal trauma describe?

Answer 26

injury resulting in tissue changes within the attachment apparatus, including periodontal ligament, supporting alveolar bone and cementum, as a result of occlusal force(s).

Question 27

what could tooth mobility indicate?

Answer 27

May indicate successful adaptation of the periodontium to functional demands and/or reflect the nature of the remaining attachment

Question 28

Tooth mobility can be accepted, unless?

Answer 28

 It is progressively increasing  It gives rise to symptoms  It creates difficulty with restorative treatment

Question 29

what is therapy used to reduce tooth mobility?

Answer 29

o Control of plaque-induced inflammation. o Correction of occlusal relations. o Splinting.

Question 30

what is primary occlusal trauma?

Answer 30

Injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal periodontal support. It occurs in the presence of normal clinical attachment levels, normal bone levels, and excessive occlusal force(s).

Question 31

what is the response of the healthy periodontium?

Answer 31

o PDL width increases until forces can be adequately dissipated, the PDL width should then stabilise o Tooth mobility will be increased as a result o This can be regarded as successful adaptation to increased demand and therefore physiological o If demand is subsequently reduced, PDL width should return to normal o If the demand of occlusal forces is too great or the adaptive capacity of the PDL reduced, PDL width may continue to increase o PDL width and tooth mobility fail to reach a stable phase o This failure of adaptation may be regarded as pathological

Question 32

what is secondary occlusal trauma?

Answer 32

o injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced periodontal support. o It occurs in the presence of attachment loss, bone loss, and normal/excessive occlusal force(s).

Question 33

what is fremitus?

Answer 33

o palpable or visible movement of a tooth when subjected to occlusal forces.

Question 34

what is tooth migration?

Answer 34

o Loss of periodontal attachment o Unfavourable occlusal forces o Unfavourable soft tissue profile

Question 35

what is management of tooth migration?

Answer 35

o Treat the periodontitis o Correct occlusal relations o Either:  (a) Accept the position of the teeth and stabilise or  (b) Move the teeth orthodontically and stabilise

Question 36

what is effect on periodontal therapy in relation to tooth mobility and occlusal forces?

Answer 36

o Decreased CAL gain post HPT. o Increased Clincal Attatchment loss over time o Mobile teeth treated with regeneration do not respond as well as non‐mobile teeth. o But no association was drawn between mobility and occlusal forces.

Question 37

studies found that teeth with occlusal discrepancies had what?

Answer 37

o deeper initial probing depths o more mobility o poorer prognoses than those teeth without occlusal discrepancies.

Question 38

how to correct occlusal relations?

Answer 38

o Occlusal Adjustment (Selective Grinding) o Restorations o Orthodontics

Question 39

Splinting may be appropriate when?

Answer 39

o Mobility is due to advanced loss of attachment o Mobility is causing discomfort or difficulty in chewing o Teeth need to be stabilised for debridement.

Question 40

however what does splinting not influence?

Answer 40

o Does not influence the rate of periodontal destruction

Question 41

what may splinting create?

Answer 41

o May create hygiene difficulties o Is a treatment of “last resort”

Question 42

Does endodontic disease affect periodontal health?

Answer 42

 When the pulp becomes infected, it elicits an inflammatory response in the periodontal ligament at the apical foramen and/or adjacent to openings of the small portals of exit

Question 43

what amtimicrobials could be used for tx of npd?

Answer 43

metronidazole 400mg TID 3 days

Question 44

what is this?

Answer 44

acute periodontal abscess