Chapter 25: Periodontal emergencies * Abscess of the periodontium- an acute, circumscribed collection of pus in the periodontium 1) Acute- condition has a rapid onset, rapid course, and can be accompanied by pain or discomfort 2) Circumscribed- abscess is localized 3) Pus- a collection of dead white blood cells that result from the body defense mechanisms involved in fighting the infection * 3 types of periodontal abscesses ) Gingival- an abscess of the periodontium that is limited to the gingival margin area. Occurs in a healthy mouth when some foreign object is forced into a healthy gingival sulcus 5) Periodontal abscess- occurs in a site with preexisting periodontal disease including preexisting periodontal pockets. Affects the deeper structures of the periodontium and is not limited to the gingival margin area only as is the gingival abscess * Treatment of gingival and periodontal abscess Anesthetize the tooth prior * Establish a path of drainage for the pus. Through the pocket itself or by performing periodontal surgery. Puncture the soft tissue wall of the pocket with the toe of a sterile curet. * Thorough periodontal debridement of the tooth surfaces in the area of the abscess * Adjustment of the tooth occlusion is usually indicated * Antibiotics may be needed in advanced cases Recommend warm saltwater rinses to help keep the abscess draining until completely healed * Dental team should appoint the patient for a thorough periodontal assessment 6) Pericoronal abscess- an infection in the soft tissue surrounding the crown of a partially erupted tooth * Most frequently seen around a mandibular 3rd molar * Operculum- Flap of gingival tissues that covers a portion of the crown. This flap can become infected.
* Pericoronitis also referred to as operculitis * Signs and symptoms * Pain Soft tissue swelling and redness * Damage to tissue covering the partially erupted tooth from the opposing tooth impinging on it * Trismus- limited mouth opening * Fever and swollen lymph nodes * Treatment * Drainage of the pus * Irrigation of the undersurface of the flap of tissue with warm saline * Relief of pain * Advanced cases may require antibiotics * Opposing tooth may have to be removed as well as the 3rd molar that was the source of the abscess * Remove the flap of tissue although recurrence may occur * Causes of abscesses ) Blockage of the orifice of an existing periodontal pocket because of temporary improvement in surface tissue tone 8) Forcing a foreign object into the supporting tissues of a tooth * Puncturing the gingiva with a toothpick will force bacteria into the tissue 9) Incomplete calculus removal in a periodontal pocket * Periodontium abscess vs. endodontic abscess 10) Abscess of the periodontium results from an infection of the periodontium * Has vital pulp * Bone loss present but does not involve the apex of the tooth * Localized, constant pain 1) An endodontic abscess results from an infection of the tooth pulp * Caused by death of the tooth pulp (nonvital pulp) from trauma or deep dental decay * Usually requires root canal treatment * Bone loss frequently seen around the apex of the tooth * Difficult to localize intermittent pain * Necrotizing periodontal disease 12) Necrotizing ulcerative gingivitis- an acute infection of the periodontium that is limited to gingival tissues * Aka Vincent’s infection and trench mouth Exhibits necrosis- death of cells comprising the gingival epithelium * Ulceration of the gingival tissue- loss of the epithelium normally covering underlying connective tissue * Appearance * Punched out papillae- necrotic papilla that has a craterlike appearance * Pseudomembrane formation- necrotic gingival areas are covered with a gray-white layer with raw connective tissue underneath * Patients exhibit bleeding with the slightest manipulation of the gingival tissues.
Bleeding results from breakage of some of the tiny blood vessels in the connective tissues that are normally protected by the epithelium * Signs and symptoms * Pain * Swollen lymph nodes with a feeling of malaise (discomfort) and elevated temperature * Halitosis * Patient characteristics * History of smoking * History of poor nutrition * Recent history of stress * HIV * Treatment * Gentle debridement of the Pseudomembrane, periodontal instrumentation of the tooth surfaces and reinstitution of gently personal plaque control * Antibiotics may be needed Rest, fluids and avoid spicy foods 13) Necrotizing ulcerative periodontitis- similar to NUG but affects the deeper structures of the periodontium and it can be accompanied by the formation of bone sequestra (dead pieces of bone) * Treatment- complex and usually requires a medical consult because the patient usually has serious underlying medical compromising conditions that must be managed simultaneously with dental therapy * Immediate referral to a periodontist is indicated when these patients are encountered * Symptoms of primary herpetic gingivostomatitis- a painful oral condition resulting rom a viral infection (HSV) 14) Usually cause by initial infection with HSVI but can be cause by HSVII 15) Contagious and usually occurs in kids or young adults, but can occur at any age 16) Once infected with the virus, the infection can recur periodically throughout the life of the patient in the form of herpes labialis 17) Signs and symptoms * Oral pain * Swollen, red, bleeding gums * Painful oral ulcers- clusters of blister that burst leaving painful ulcers. These ulcers are surrounded by a red halo.
Found on the lips, palate, gingival tissue and tongue * In more severe cases- pain, elevated temperature, malaise, headache, and swollen lymph nodes 18) Treatment * Goes away without treatment in 12-20 days * Control discomfort and drink fluids * Antiviral meds to reduce fever (antipyretics) * Systemic meds to control pain (analgesics) * Topical oral anesthetics can be used to control oral discomfort temporarily so the patient can eat and drink * 2% lidocaine viscous * Orabase with benzocaine