Chapter 9: Acute Periodontal Diseases

Sudden onset, rapid progression, pain and discomfort, may be unrelated to preexisting gingivitis or periodontitis, localized or generalized, may present with systemic involvement

acute periodontal diseases characteristics

Gingival Abscess, periodontal Abscess, pericoronal Abscess, Endodontic-Periodontic Lesion (EPL), Necrotizing Diseases, Primary Herpetic Gingivostomatitis

Types of acute conditions

A circumscribed, fluctuant collection of ____, localized w/in gingival wall and perio ____ is an _____

pus, pocket, abscess of the periodontium

Precise bacterial etiology of periodontal abscess is unclear. Most lesions contain bacteria that is _______

Gram negative (-) & anaerobes

Pus is a whitish-yellow milky-like exudate made of dead & dying ____, bacteria, cellular debris and fluid leaked from blood vessels. _____ liquification of pus

neutrophils, suppuration

___ localized to a specific site

Circumscribed

Causes of abscess of the periodontium include blockage of _____, foreign object blockage, incomplete calculus removal

orifice of pocket

Swelling, operculitis (infection of the third molar space), possible trismus, fever lymphadenopathy

Signs and symptoms of abscesses of the periodontium

Establish path of drainage, perio instrumentation of tooth in in area affected, pain management

Management of abscesses of the periodontium

Common dental emergency, Rapid perio destruction & tooth loss, Link btwx perio abscesses & systemic diseases

Implication of abscesses of the periodontium if untreated

no pain or dull pain

chronic abscess

characteristics abscess of the periodontium include ______, possible increase in tooth mobility, radiographic loss of alveolar bone not involving tooth apex, usually ______, fever may occur but not common (serious if present), if delayed pus may drain through sinus tract

circumscribed swelling, vital pulp

nonvital pulp, bone loss at apex of tooth, difficult to localize

Pupal abscess

vital pulp, bone loss at angular defect or furcation, localized constant pain

Periodontal abscess

______ is an acute infection of periodontium, ______ is a pupal infection, rapid onset, tooth pain, percussion sensitivity swelling, pus formation, radiolucency at apex

Perio abscess, periapical abscess

There are two different sources for periodontal and pupal abscesses ____ and _____. They are very similar, overlapping signs and symptoms

Periodontium itself and pupal tissue

Rapid onset characterized by pain and discomfort. Primarily caused by exacerbation of chronic inflammatory periodontal lesion

Acute abscess

Grows slowly and is not typically associated with pain, forms after spread of infection controlled by spontaneous drainage, host response, or therapy

chronic abscess

_____ is primarily limited to the ____ or ______ w/out involvement of deeper perio structures

Gingival abscess, gingiva, interdental papilla

____ involves deeper perio structures as well as _____. Occurs in site w/ preexisting perio disease or perio pocket

Periodontal abscess, gingiva

_____ involves tissue around partially erupted crn

periocoronal abscess

____ involves soft tissue inflammation associated with abscess

Periocoronitis

_____ include administering LA, drain pus, perio instrumentation, adjust occlusion, rx Anti-infective therapy if needed, warm salt H20 rinses, rx pain meds if needed, establish follow up appt

Tx of gingival and periodontal abscesses

______ fundamental Tx: path of drainage, irrigation, perio instrumentation, pain relief, administer LA, Drain pus, perio instrumentation & irrigation under operculum, rx anti-infective therapy, Warm salt H20 rinses, rx pain meds, Evaluate for Ext of 3^rd molars, establish follow up appt, If reoccurs; reassess if surgical excision of operculum or ext of tooth is needed

Tx of pericoronal abscess

______ formerly known as “combined periodontal endodontic lesion”, infection of pulp & perio of same tooth, source can be perio or pulp (two infections at the same time

Endodontic-periodontal lesion

_____ infection enters tooth via accessory canals and or apical foramen of the root, initiates inflammatory changes in the pulp root complex

Periodontally derived lesion

______ infection escapes out the tooth root triggers secondary infection of periodontium

pulpally derived lesions

Deep pocket near apex, negative or altered response to pulp tester, bone resorption in furcation or apex of the tooth, spontaneous pain, pain w/ percussion or palpation, suppuration, tooth mobility, sinus tract & color changes in gingiva

signs and symptoms of endodontic periodontal lesions and pathophysiologic routes

Distinct characteristics: Interdental tissue necrosis, intense gingival pain, and spontaneous gingival bleeding, Secondary clinical characteristics: Fetid breath, pseudomembrane formation, and systemic involvement

Necrotizing periodontal disease

Noncommunicable destructive, inflammatory disease, limited to gingival papilla & marginal gingiva,

Necrotizing gingivitis (NG)

Vincent’s Disease, Fuso-spirochetal Gingivitis, Trench mouth, Ulceromembranous gingivitis, Acute Necrotizing Ulcerative Gingivitis, Necrotizing Ulcerative Gingivitis ( no longer valid)

Synonyms for necrotizing gingivitis

Fusiform and spirochete bacteria found deep in NG lesions, more recent diverse array of bacteria found, invasion of bacteria before or after onset is debated, inflammatory reaction plays a role in development of NG, HIV at High risk for it

etiology of necrotizing gingivitis (NG)

Can affect anyone but, 20-30 years of age common, lower occurrence in developed countries, 95% of cases in North America is Caucasian

Necrotizing gingivitis

Gingival Necrosis & ulcers of gingival papilla, bleeding, pain pseudomembranous membrane, halitosis, lymphadenopathy, fever. Punched out papilla, spreads from papilla to marginal gingiva, most often man. anterior teeth

Conditions/characteristics of necrotizing gingivitis

Reduce discomfort, arrest perio disease, restore form & function of perio, preserve stability of perio.

Management of tx of necrotizing diseases

Remove pseudomembranous membrane and soft deposits, self care

Step 1 tx of necrotizing diseases

Subgingival perio instrumentation, further self care to control systemic predisposing factors _____

step 2 tx of necrotizing diseases

complete subgingival scaling, eval pt resolution of symptoms, further pt counseling, severe cases may need Rx ____

step 2 tx of necrotizing diseases

Maintenance Phase, Access perio status, Reinforce Self care, control predisposing factors, perform instrumentation, factor in pt compliance

Step 4 tx of necrotizing diseases

_____ has same clinical features as necrotizing gingivitis, but tissue necrosis spreads to underlying periodontal attachment apparatus. Can lead to bone loss and clinical attachment loss. Similar to necrotizing periodontitis treatment, but may be more complex due to extensive, irreversible tissue destruction. Referral to periodontist recommended. Close collaboration with patient’s medical practitioner also warranted

Necrotizing periodontitis

______ an extension of NG or NP where necrosis progresses to deeper tissues beyond mucogingival line. Symptoms similar to those of NG and NP. Rare, but most extensive and invasive form of NPD. Refer immediately to oral pathologist, oral maxillofacial surgeon, and physician

Necrotizing stomatitis

_____ is a herpes simplex virus (HSV). Most often HSV-1. Spread by direct contact, can also be spread from one body part to another; contagious. Unnoticeable in some patients, but severe symptoms in others. Most common in children and young adults, but can occur at any age. Stress, trauma, sunlight, and fever

Primary Herpetic gingivostomatitis

Prodrome, macule, papule, vesicle, ulcer, scab, healed area with redness, and complete healing. Vesicle and ulcer stages most important from dental management standpoint

Several stages for primary herpetic gingivostomatitis

Oral pain, difficulty eating & drinking, swollen and/or bleeding gingival tissue, vesicles & ulceration of gingival tissue, lips, tongue, and/or palate, w/ ulcerations surrounded by red halo, elevated body temp, malaise, swollen lymph nodes

Clinical signs of primary herpetic gingivoatomatitis and management

Defer elective dental treatment until HSV-1 lesion scabbed over or completely healed, regresses spontaneously in about 2 weeks, control oral comfort with topical oral anesthetics mouth rinses, recommend frequent fluid intake to avoid dehydration, refer to physician if systemic symptoms severe

Management clinical signs of primary herpetic gingivostomatitis and management