Periodontitis
Download
Report
Transcript Periodontitis
Periodontitis
Acute periodontitis
Acute inflammation of the perodontal ligament gradually
involving the whole periodontium
Causes (4I)
Injury: trauma due to external force or bite on hard object
Infection: Pulpitis, ANUG
Irritation due to improper filling
Impaction of foreign body (meat bone)
Etiological agent – Streptococcus, Staphylococcus, Borrelia vincenti
Fusiform bacillus
Dr S Chakradhar
1
Clinical features
Toothache
Patient feels that the tooth is
extruded
Fever
Malaise
Enlarged cervical LN
Dr S Chakradhar
4
Management
Treat/remove the cause
Soft diet
Advise not to chew from affected side
Gargle with warm saline
Analgesics and anti inflammatory
Antibiotics
Prevent further damage by proper oral
hygiene
Dr S Chakradhar
5
Periapical abscess
Usually a progression of periodontitis
History
Severe throbbing pain
Tenderness
Diffuse swelling
Fever
On examination
Inability to occlude
Fluctuant swelling in buccal or lingual region
Sensitive to percussion
Mobility
X ray may show periapical radiolucency
Management
Incision and drainage
Don’t give local infiltration as chances of
dissemination of infection is there
Antibiotic coverage
Analgesic
Maintenance of oral hygiene
Chronic periodontitis
Causes
Chronic gingivitis
Occlusal trauma
Improper application of orthodontic appliance (excess force)
Pathology
Destruction of periodontal ligament
Formation of periodontal pocket
Resorption of alveolar bone
Loosening of teeth
Clinical features
Features of chronic gingivitis
Swollen, soft, discolored
Bleeds on probing
Gingival pocket ( >4mm)
False pocket if gingiva is elongated towards crown.
Recession of gum margin
Mobile tooth
Halitosis
Management
Maintain oral hygiene
Brushing
Mouth
Scaling
wash
to remove plaque and calculi
Subgingival curettage of pocket, to allow
normal reattachment of gingival and
periodontal tissue
Mucogingival flap operation: curettage of
granulation tissue, dead bone and
cementum beneath a flap of gingiva
Complications
Intraoral and extraoral abscess
Maxillary sinusitis
Ostemyelitis of jaw
Cellulitis of face
Dissemination of infection: bacteremia,
septicemia
Pericoronitis
Inflammation of the gingival tissue around an erupting tooth
When the eruption is partial, there is an opening through the
mucus membrane and
rest of the crown is covered by a flap of gum which is known
as operculum
Commonly occurs in the lower 3rd molar at the age of 18 to 25
yrs
But any tooth can be affected
Causes
Food stagnation and impaction
Upper tooth traumatizing lower gum
flap
Vincent’s infection – acute gingivitis
caused by borella vincemtis &
fuscobacterium
Eruption irritation
Immunocompromised host
Clinical features
Pain
Swollen operculum
Trismus
Halitosis
Fever and enlarged cervical LN
Purulent exudate
Abscess formation
Management
Clean with 3%H2O2
Nascent O2 is bactericidal
Normal saline wash
Maintain oral hygiene
Brushing
Antiseptic mouthwash
Chlorhexidine, Betadine,
Soft diet
Analgesic and anti inflammatory
Amoxycillin 500mg tds for 5 to 7 days
Or Erythromycin 250mg qid for 5 to 7 days
Operculectomy
Removal of upper tooth may be necessary