Perio Final Exam - Lecture 5

Front 1

Description of symptoms.

Back 1

(1) type of pain
(2) Onset
(3) duration
(4) fever
(5) purulence

Front 2

Radiographic evaluation

Back 2

(1) Caries?
(2) Endo failure?
(3) Periapical lesion
(4) pattern of bone loss.

Front 3

Intraoral eval.

Back 3

(1) caries
(2) Fractures/faulty restoration
(3) fractured tooth/occlusion
(4) deep probing depths
(5) mucosal abnormalities
(6) combination?

Front 4

Characteristics of inflammation.

Back 4

Redness
Pain
Heat
Swelling
Loss of function
May also be associated with "flu-like conditions" such as fever, chills, fatigue/loss of energy, headaches, loss of appetite, muscle stiffness

Front 5

Factors of Inflamation.

Back 5

(1) Naturing of the inciting agent
(2) Time of observation
(3) Immune Status of Host

Front 6

Acute Response.

Back 6

(1) Transudate and exudate
- Movement of fluid of low protein content containing albulumins and acute phase proteins from the intravascular to extravascular space.
(2) Neutrophil - rich exudate
Influx of PMN's
appears within hours
Profound microbial killing capacity
Secretion of enzymes capable of digesting host tissue components

Front 7

Neutrophil Rich Exudate.

Back 7

- Elicited primarily in response to pyrogenic microbial infections.
- Accounts for the histological appearance of supparation.
- intact and disintegrating neutrophils within a background of fragmented and liquefied tissue elements.

Front 8

Acute Gingival Diseases.

Back 8

Acute Gingival Abscess.
Acute herpetic Gingivostomatosis.
Acute pericornitis
ANUG - Acute Necrotizing Ulcerative Gingivitis

Front 9

Acute Gingival Abscess.

Back 9

- A localized, painful, rapidly expanding lesion.
- Usually of sudden onset.
- Generally limited to marginal gingiva or interdental papilla.
- Red swelling with a smooth shiny surface
- within 24-48 hours, becomes fluctuant and pointed - a surface orifice may be present from which a purulent exudate may be expressed.

Front 10

Gingival Abscess etiology.

Back 10

Penetration of bacteria along with other solid material into the gingiva.
Often occurs in previous disease-free area

Front 11

Gingival Abscess: Treatment Goal and Treatment regimen.

Back 11

Txt Goal: reversal of acute phase and when possible, removal of offending agent.
Treatment regimen: Anesthesia, SRP to establish drainage and remove microbial deposits and foreign material. May require excission with #15 blade. Express exudate with firm digital pressure. Irriatage with saline. Patient rinse with warm salt water every 2 hours. Reasses at 24 hours. If lesion persists and access is poor - consider surgery.

Front 12

Treatment for Acute Herpetic Gingivostomatitis.

Back 12

- Palliative or Interventional.
- Palliative: NSAIDS and viscous lidocain or 1-2-3 mouthrinse
(1) Dimetapp elixir 40 ml
(2) Kaopectate 80 ml
(3) Distilled water 120 ml
Use prn. Shake well before use Rinse with 1 tps for 1-2 minutes and expectorate.

Front 13

Treatment Alternatives for Acute AHerpatic Gingivostomatitis:

Back 13

(1) Interventional: useful if wihtin 3 days of onset.
Acyclovir 15 mg/kg five times daily for 7 days.
- NSAIDS
- Viscous Lidocain: 1-2-3 mouthrinse

Front 14

ANUG

Back 14

- painful, ulcerative condition
- assoicated with impaired host reponse to microflora.
-

Front 15

ANUG - Treatment Sequence Overview:

Back 15

- Alleviation of acute inflamation: reduction of microbial load and removal of necrotic tissue
- Treatment of chronic disease
- Alleviation of generalized symptoms
- Correction (address) systemic conditions

Front 16

Head and NEck oral exam for ANUG.

Back 16

(1) Halitosis
(2) Enlarged Lymph node
(3) Fever
(4) Defer probing depth due to pain
(5) Skin Lesions

Front 17

1st Visit Goals of ANUG

Back 17

Reduce the microbial load and remove necrotic tissue.
Ab are for Rx for moderate to severe cases with lymphadenopathy and fever
-Amoxicillan 500 mg every 6 hours for 10 days
- PCN allergy: Erytrhomycin 500 mg every 6 hours or metronidazole 500 mg 12 hours for 7 days.
- Unless emergency exists, delay further treatment for 4 weeks to minimize exacerbating the acut symptoms.

Front 18

Patent instructions for ANUG.

Back 18

(1) Avoid toacco and alcohol
(2) Rinse with glassful of water with H2O2 or chlorohexidine
Rest
Oral Hygiene: dentrifice biotene with soft TB and no flossing
OTC analgesic as needed.

Front 19

ANUG second visit: 24-48 hours later.

Back 19

Re-evaluation of improvment of signs and symptoms.
Scaling performed if necessary and sensitivity persists.

Front 20

ANUG Third visit: 5 days after 2nd visit.

Back 20

- re-evaluation for improvment of signs and symptoms
- free of symptoms
- discontinue H2O2 and chlorohexidine rinses
- Stress OHI, etiology, recal 3-6 months
- Re-eval tissues at 1 monthContinue with other needs.

Front 21

Etiology of Odontogenic Infections.

Back 21

- Of indigenous bacterial origin
- Polymicrobial: Aerobic: 5% Anearobic: 35%; Mixed: 60^
- Antibiotics alone can help control the infection, but when stopped infection will recur

Front 22

Origins of Odontogenic Infections: (1) Periapical and (2) Periodontal

Back 22

(1) Periapical: pulpal necrosis and subsequent bacterial invasion into periapical tissues
(2) Periodontal: deep periodontal pocket that allows inocultion of bacteria into the underlying soft tissue

Front 23

Chronic Abscess

Back 23

- infectious, supparitive inflammatory event associated with a pyogenic organism
- most often an acute excacerbation of chronic conditions
- occurs when pyogenic stimulus is not readily eliminated
- localized collection of pus caused by supparation within tissue, organ or confined space
- produced by deep seating of pyogenic bacteria into tissues
- in time the infection may be walled off my connective tissue limiting further spread

Front 24

Spread of Abscess or infection.

Back 24

(1) Spread of infection in path of least resistance
(2) cancellous bone --> cortical bone
(3) If plate is thin, erodes the one and invades soft tissue.
Determined by (1) bone thickness and (2) position with regards to muscle attachment (inferior - buccal attachment; superior - flesh)

Front 25

What is a periodontal abscess?

Back 25

A localized accumulation of pus within a ginigval wall of a periodontal pocket.

Front 26

What is the etiology of a periodontal abscess?

Back 26

(1) Chronic Periodontitis
(2) Blunt trauma to the tooth, root fracture, perforation of root during endodontic or restorative therapy.

Front 27

What is the appearance of acute periodontal abscess?

Back 27

- Appears as an oviod elevation of the gingiva along the lateral aspects of the root.
- Gingiva is edematous and red with a smooth, shiny surface.
- Area may be dome like and relatively firm or pointed or soft.
- Pus may be expressed with gentle digital pressure.

Front 28

Differentiate b/w acute and chronic absess.

Back 28

(1) Acute - has pain, presents as ovioid with swelling, mobility, tenderness to biting, purulent, not usually a fistula
(2) Chronic - may be no pain, it may not present, there is excursion of the tooth, there is intermittant purulence, and there is a fistula present.

Front 29

Describe the primary periodontal problem.

Back 29

- tooth is generally vital
- generalizd bone loss
- plaque/calculus
- soft tissue inflammation
- broad based pockeet formation
- occlusal trauma?

Front 30

Describe the primary endodontic/pulpal lesion.

Back 30

- sinus tract formation through the periodontium
- some degree of tooth mobility
- varying degree of bone loss
- furcation of bone loss
- narrow pocket formation
- swelling in the attached ginigva
- soreness/pain to percussion
- tooth may present with large restration or caries.

Front 31

In a combined lesion - which do you treat first?

Back 31

- treat endodontic lesion first.
-then periodontal
The prognosis depends on the extent of the periodotal involvment and tooth restorability.

Front 32

Treatent for acute periodontal abscess.

Back 32

- Purpose of txt is to alleviate pain, control spread of infection, and establish drainage.
- Drainage is established through periodontal pocket or external excision.

Front 33

Treatment for Chronic periodontalabscess.

Back 33

- SRP, systemic AB
- Periodntal flap surgery if lesion persists or reocurrs
- Full thickness flap is reflected
- Calculus, offending agent is removed
- Bone is recountered, granulation tissue is removed and sutures placed
- Chlorohexiine rinse and Ab Rx.

Front 34

Describe Cellulitis.

Back 34

- Aerobic microorganism (e.g. streptococci)
- Acute
- Edematous
- Doughy to indurate in consistency
- Innocuous in its early stages
- Dangerous in its advance, rapidly spreading stages.

Front 35

What is the difference between an abscess and cellulitis?

Back 35

Abscess- small in size, well circumscribed, fluctuant, purulent, not as serious, anaerobic bacteria
Cellulitis - large size, diffuse borders, doughy to indurated, not purulent, more serious, areobic bacteria.

Front 36

Treatment of Pericoronitis.

Back 36

- Fluh area with sterile saline
- Swabbing with antiseptic after elevating flap from the tooth with a scaler - debrisremoved
- If fluctuant - incise and drain
- May need to reflect/excise pericoronal flap.
- offending teeth may require ext
- Ab (fever)