The role of the OHT in the Management of acute periodontal and endo-periodontal lesions Flashcards
Define the terms “gingival and pericoronal abscess”
Gingival:
• Localised, acute inflammatory lesion on the gingival margin (with pus)
• Tissues are still periodontally healthy
Pericoronal :
• Abscess of the tissues (operculum) around the crown of a partially erupted tooth
• Seen on mandibular third molars
Define the term “periodontal abscess” in terms of: • Location • Its effects • Who it affects • Causes of it
Location:
• Destructive lesion found in the soft tissue wall of a deep periodontal pocket
Effects:
• Localized area of exudate forms, but the pus has nowhere to drain so infection spreads to tissues and bone (can cause rapid and extensive bone loss)
Affects:
• Occurs most often in adults; rare in children
Causes:
• Due to changes in subgingival microflora and host resistance or both
• Arises in pre-existing periodontal lesion
• Can occur following instrumentation
State the common (5) and uncommon (2) causes of gingival abscesses
Infectiondue: • Caries • Traumatic brushing • Broken teeth • Foreign body in gum line • Microbial plaque infection
Other causes:
• Traumatic injury
• Excessive orthodontic force
State the bacteria (type and names) involved in periodontal abscesses
- Anaerobic cocci
- Anaerobic gram-negative bacilli
- Anaerobic gram-positive bacilli
Explain why periodontal abscesses are important
Is considered a dental emergency that requires immediate treatment because:
• They can cause rapid destruction of the periodontium
• Can negatively impact the prognosis of a tooth
Describe the common (5) and uncommon factors (2) associated with the development of a periodontal abscess
Commonly:
• Closure of the entrance into a periodontal pocket
• Entrapment of foreign body (E.g. popcorn husk, seeds, calculus)
• Furcation involvement
• Diabetes
• Systemic antibiotics (given for non-oral infections) can lead to super infection by opportunistic organisms, resulting in development periodontal abscess
Uncommonly:
• Trauma e.g. root fracture
• Anatomic dental anomalies e.g. enamel pearls
Describe the risk factors associated with the development of a pericoronal abscess (4)
- Accumulation of bacteria and debris beneath the operculum
- Mechanical trauma (e.g. biting the operculum with the opposing tooth).
- Tooth impaction (makes it more likely)
- Supernumerary teeth (makes it more likely)
Describe the clinical signs and symptoms and radiographic presentation of a gingival abscess
Clinical signs: • Red • Smooth • Painful • Fluctuant swelling
Radiographic signs:
• No detectable bone loss
Describe the clinical signs and symptoms and radiographic presentation of a periodontal abscess, while also describing chronic and acute abscesses
Clinical signs:
• Zone of gingival enlargement along lateral aspect of a tooth
• Can occur on lateral aspect of root
• Probing/ gentle pressure results in exudate release
• Gingiva is erythamtous
• Gingiva is odeamatous (swollen)
• Gingiva can be haemorrhagic and is dark red in colour
May be acute or chronic: Acute: • extreme pain • sensitivity • mobility • exudate expressed from gingival margin
Chronic:
• usually asymptomatic or episodes of dull pain
• elevation of tooth
• sinus tract opening onto gingival mucosa along root
Radiographic signs:
• Radiolucency around root of tooth
• Destruction of the PDL space
Describe the clinical signs and symptoms and radiographic presentation of a pericoronal abscess
Clinical signs: • Inflamed erythematous operculum • Trismus • Dysphagia • Pain that radiates to TMJ • Pus appearance • Halitosis
Radiographic signs:
• No detectable bone loss
State the symptoms patient’s experience associated with periodontal abscess (8)
- Throbbing pain or no pain
- Extreme sensitivity to palpation
- Sensitivity, mobility or extrusion of adjacent tooth
- Foul taste
- Lymphadenopathy
- Fever
- Leukocytosis (WBC count above normal range)
- Sometimes malaise
Differentiate, perio-endo, endo-perio and combined lesions
- Periodontal-Endodontal Lesion: bacterial infection from a periodontal pocket may spread through accessory canals to pulp resulting in pulpal necrosis
- Endodontic-Periodontal Lesion: pulpal necrosis precedes periodontal changes
- Combined Lesion: occurs when pulpal necrosis and periapical lesion occur on a tooth that had periodontal involvement
What is the effect of pulpal infections on the bone?
- Can lead to a periapical radiolucency that migrates cervically.
- Mandibular molars with accessory canals will experience this in a lateral orientation or in the furcation area
What is the effect of periodontal infections on the bone?
- Leads to extensive breakdown of alveolar crest bone that starts at the cervical area and migrates to the apex (of the tooth)
- Results in generalized bone loss around a single tooth or multiple adjacent teeth
Discuss the characteristics of a periodontal abscess in terms of:
Site of pain
Site of discharge
Site of swelling
Chronological order of pain and swelling
Tender to percussion
Pocket formation
Associated with trauma or a restoration
Associated with previous symptoms of pulpitis
Tooth vital
Site of pain:
• Gingiva
Site of discharge:
• Through pocket
Site of swelling:
• Towards gingiva
Chronological order of pain and swelling:
• Swelling occurs before pain
Tender to percussion:
• No
Pocket formation:
• Yes
Associated with trauma or a restoration:
• No
Associated with previous symptoms of pulpitis:
• No
Tooth vital:
• Yes
