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36 Cards in this Set
- Front
- Back
Description of symptoms.
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(1) type of pain
(2) Onset (3) duration (4) fever (5) purulence |
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Radiographic evaluation
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(1) Caries?
(2) Endo failure? (3) Periapical lesion (4) pattern of bone loss. |
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Intraoral eval.
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(1) caries
(2) Fractures/faulty restoration (3) fractured tooth/occlusion (4) deep probing depths (5) mucosal abnormalities (6) combination? |
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Characteristics of inflammation.
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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 |
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Factors of Inflamation.
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(1) Naturing of the inciting agent
(2) Time of observation (3) Immune Status of Host |
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Acute Response.
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(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 |
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Neutrophil Rich Exudate.
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- 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. |
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Acute Gingival Diseases.
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Acute Gingival Abscess.
Acute herpetic Gingivostomatosis. Acute pericornitis ANUG - Acute Necrotizing Ulcerative Gingivitis |
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Acute Gingival Abscess.
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- 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. |
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Gingival Abscess etiology.
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Penetration of bacteria along with other solid material into the gingiva.
Often occurs in previous disease-free area |
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Gingival Abscess: Treatment Goal and Treatment regimen.
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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. |
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Treatment for Acute Herpetic Gingivostomatitis.
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- 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. |
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Treatment Alternatives for Acute AHerpatic Gingivostomatitis:
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(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 |
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ANUG
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- painful, ulcerative condition
- assoicated with impaired host reponse to microflora. - |
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ANUG - Treatment Sequence Overview:
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- 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 |
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Head and NEck oral exam for ANUG.
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(1) Halitosis
(2) Enlarged Lymph node (3) Fever (4) Defer probing depth due to pain (5) Skin Lesions |
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1st Visit Goals of ANUG
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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. |
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Patent instructions for ANUG.
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(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. |
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ANUG second visit: 24-48 hours later.
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Re-evaluation of improvment of signs and symptoms.
Scaling performed if necessary and sensitivity persists. |
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ANUG Third visit: 5 days after 2nd visit.
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- 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. |
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Etiology of Odontogenic Infections.
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- Of indigenous bacterial origin
- Polymicrobial: Aerobic: 5% Anearobic: 35%; Mixed: 60^ - Antibiotics alone can help control the infection, but when stopped infection will recur |
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Origins of Odontogenic Infections: (1) Periapical and (2) Periodontal
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(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 |
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Chronic Abscess
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- 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 |
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Spread of Abscess or infection.
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(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) |
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What is a periodontal abscess?
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A localized accumulation of pus within a ginigval wall of a periodontal pocket.
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What is the etiology of a periodontal abscess?
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(1) Chronic Periodontitis
(2) Blunt trauma to the tooth, root fracture, perforation of root during endodontic or restorative therapy. |
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What is the appearance of acute periodontal abscess?
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- 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. |
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Differentiate b/w acute and chronic absess.
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(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. |
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Describe the primary periodontal problem.
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- tooth is generally vital
- generalizd bone loss - plaque/calculus - soft tissue inflammation - broad based pockeet formation - occlusal trauma? |
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Describe the primary endodontic/pulpal lesion.
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- 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. |
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In a combined lesion - which do you treat first?
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- treat endodontic lesion first.
-then periodontal The prognosis depends on the extent of the periodotal involvment and tooth restorability. |
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Treatent for acute periodontal abscess.
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- Purpose of txt is to alleviate pain, control spread of infection, and establish drainage.
- Drainage is established through periodontal pocket or external excision. |
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Treatment for Chronic periodontalabscess.
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- 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. |
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Describe Cellulitis.
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- Aerobic microorganism (e.g. streptococci)
- Acute - Edematous - Doughy to indurate in consistency - Innocuous in its early stages - Dangerous in its advance, rapidly spreading stages. |
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What is the difference between an abscess and cellulitis?
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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. |
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Treatment of Pericoronitis.
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- 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) |