Periodontal Abscess

PeriodontalAbscess

Periodontal abscess is seen almost exclusively in patients with existing periodontal disease and/or uncontrolled diabetes.

The discomfort associated with the swelling, is usually not enough to keep the patient awake at night.

Pain is often difficult to locate. The flora associated with periodontal abscess is more mixed than with most other periodontal infection.

periodontal abscess
Periodontal abscess is clearly visible as red swollen area associated with maxillary canine and premolar.

Q. What is the treatment of periodontal abscess?

Answer: Mechanical or surgical access to the tooth root of any plaque and calculus.

In advance cases, extractions may be considered.

If systemic signs and symptoms are present, or if patient is not responding to local treatment, antimicrobial therapy should be considered.

  1.      Phenoxymethylpenicilline 500 mg four times a day, 5 days in (children:10 mg/kg body weight up to 500mg for 5 days)

Or

  1.      Amoxicillin 500mg, 3 times a day, for 5 days;

In case of hyprsensitivity to penicillin, give

  1.      Clindamycin 500 mg (child: 10 mg/kg up to 500 mg) orally, 3 times a day for 5 days.

Patients who are not responding to treatment and are desirous of  retaining their teeth require management by a specialist

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Acute Ulcerative Gingivitis

Introduction

Acute ulcerative gingivitis which was previously known as acute necrotizing ulcerative gingivitis, trench mouth, and Vincent's disease, is an extremely painful infection of the periodontal tissues.

 

Signs & Symptoms

  • It is characterized by punched out inter-dental papilla, ulcers often covered with a grayish membrane and, usually have fetid odor.
  • It is rarely associated with systemic signs and symptoms.
  • Acute ulcerative gingivitis is most commonly seen in young adult smokers.
  • It is rarely seen in children, acute herpetic gingivo-stomatitis is sometimes diagnosed as a acute ulcerative gingivitis.

 

 

Treatment

  • Irrigation and debridement of the necrotic area and tooth surfaces.
  • Oral hygiene instructions, oral rinses, pain control, and management of systemic manifestations including appropriate antibiotic therapy as necessary.

 

  • The initial management of acute ulcerative gingivitis is usually local debridement that is scaling and root planning under local anesthesia.
  • It should be accompanied by improved plaque control with the adjunctive use of chlorhexidine mouthwash, smoking cessation counseling and metronidazole.

 

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Management

When systemic signs and symptoms are present, use the following:

  • Metronidazole 400 milligram, 8 to 12 hourly for 5 days
  • Chlorhexidine 2% mouth was 10 ml rinsed in mouth for 1 minute, 8 to 12 hourly.

Or

  • Chlorhexidine 0.12 percent mouthwash, 15 ml in mouth for 1 minute 8 to 12 hourly.
  • Metronidazole is often given as 200 milligrams orally 3 times daily, however, it is recommended as 400 mg 12 hourly. It is considered to increase patient adherence to the treatment.
  • Antibiotic therapy alone without debridement and oral hygiene improvement, invariably lead to recurrence in most cases. In an unresponsive case, in patients with HIV infection, specialist referral is indicated.
  • Acute ulcerative gingivitis can spread to involve the underlying bone, it should be treated by a specialist.

.

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Article written by Dr. Ajai Singh

Ref: Therapeutic guidelines 2008

 

 

Gingivitis

periodontitis

Q1. What is gingivitis?

Answer:

  •         Gingivitis is inflammation of gingival tissues.
  •         Gingivitis is restricted to the gingiva.
  •         Gingiva becomes red and swollen, and bleeds easily.
  •         It is rarely painful and with correct, treatment, is reversible.
  •         Gingivitis develops because of the presence of an undisturbed bacterial bio-film, known as plaque in the gingival crevices and adjacent to the gingival margins.
  •         The gingival inflammation caused by this bio-film is a nonspecific inflammatory response to the diffusion of bacterial antigenic product into the adjacent gingival tissues.
periodontitis
Papillary gingivitis: evident by swollen interdental papillae.

Q2. What is the management of gingivitis?

  •         Gingivitis should be managed by a dentist.
  •         The objective of the treatment is to remove the plaque by meticulous dental cleaning and smooth any roughness on the teeth that   allows plaque to accumulate; for example, removal of the calculus.
  •         This should be combined with patient education about oral hygiene.
  •         Calculus deposits are removed by dental scaling. Complete resolution of the inflammation can be expected within one week.

When inflammation restricts normal brushing, the short-term use of mouthwash to inhibit supra-gingival plaque formation may be used. The following medicines can be prescribed:

  •         Chlorhexidine 0.2 % mouthwash 10 ml rinsed in mouth for 1 minute 8 to 12 hourly for 5 to 10 days.

Or

  •         Chlorhexidine 0.12 % mouthwash 15 ml rinsed in mouth for 1 minute 8 to 12 hourly for 5 to 10 days.

 

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Article written by Dr. Ajai Singh

Ref: Therapeutic guidelines 2008

Periodontal Disease

photograph showing periodontitis

Q1. What is periodontal disease?

Answer: Periodontal disease is inflammation of the gingivae and the supporting structure of the teeth- the periodontal ligament, the cementum and the alveolar bone.

 

Q2. What are the common forms of the periodontal disease?

Answer: The most common forms of periodontal disease present as chronic conditions. There are two major forms of chronic periodontal diseases:

  1. Plaque induced gingivitis
  2. Periodontitis.
photograph showing periodontitis
Periodontitis: You can clearly see the spontaneous gum bleed. The calculus deposits are present in the receded gingivae.

Periodontitis has two major variations

  1. chronic periodontitis
  2. aggressive periodontitis

Acute forms of periodontal disease include

  1. acute ulcerative gingivitis
  2. periodontal abscess

 

Q3. What are the causes of periodontal disease?

Answer: Periodontal disease is caused by dental plaque.

Dental plaque is a complex bio-film of microorganisms and their by-products that builds up on the teeth surface.

Plaque can calcify to become calculus.

The accumulation of plaque and calculus is associated with poor oral hygiene, that is, the teeth have not been cleaned thoroughly and/or often enough.

 

Q4. What are the different stages of periodontal disease?

Answer: In the early stage of periodontal disease, bacteria in plaque cause inflammation of the gingivae. This inflammatory condition of gingivae is known as gingivitis.

In some patients, untreated gingivitis progresses to a more advanced stage of periodontal disease called "periodontitis".

Periodontitis may result in loss of the bone and the tissue that support the teeth.

As gingivitis progress, periodontal pockets are formed, and the gingivae may recede from the teeth.

As a result of damage to the supporting tissues, the teeth can become loose and may eventually exfoliate or require extraction.

Q5. How can periodontal disease be treated?

Gingivitis can usually be treated successfully by removal of the plaque and calculus which is to be followed by thorough and regular oral hygiene practices.

Article written by Dr. Ajai Singh

 

Ref: Therapeutic guidelines 2008

Suppurative Mechanism: How Does the Pus Form in An Abscess?

Suppurative inflammation involves the production of large amounts of pus. The generation of chemotaxins by bacteria results in a dense accumulation of neutrophils which undergo autolysis by their own lysosomal enzymes.

Photo: Dental Abscess

Release of proteases and activated oxygen metabolites by neutrophils results in tissue destruction. Pyogenic bacteria are resistant to destruction either because they possess antiphagocytic properties or are able to kill neutrophils. For phagocytosis to occur, the bacteria must first be coated by opsonins, principally IgG and complement component C3b. Ingestion of bacteria stimulates the hexose monophosphate shunt, the end product of which is pyruvate. Pyruvate is converted to lactic acid which lowers the pH within the lesion. Drainage of pus reduces pressure and relieves pain, but suppuration continues until the causative agent has been eliminated.

 

 

Reference:

URL  - http://dx.doi.org/10.1111/j.1747-4477.1997.tb00064.x

Dental Caries

dental caries in mandibular molar

Dental caries or tooth decay and periodontal disease are probably the most common chronic diseases in the world.

Although caries has affected humans since prehistoric times, the prevalence of this disease has greatly increased in modern times due to dietary changes.

However, evidence now indicates that this trend has begun to decline in many countries in the late 1970 and early 1980 and the decline was most notable in certain segments.

Definitions

Dental Caries:

Dental Caries is an infectious microbiological disease of the teeth that results in localised dissolution and destruction of calcified tissues of the teeth.

dental caries
Advance stage of dental caries in upper first molar.

It is very important to understand that cavitations in teeth are the signs of bacterial infection in clinical practice and not the disease itself.

It is possible to lose sight of this fact and focus entirely on the restorative treatment of the carious legions thereby, failing to treat the underlying cause of the disease.

The evidence for the role of bacteria in the genesis of caries.

Overwhelming animals and human models have been used in an extensive series of studies leading to the following conclusions:

  1. Teeth free from bacterial infection either in germ free animals or un-erupted teeth in humans do not develop caries.
  2. Oral bacteria can demineralised the tooth in in-vitro and produce lesions similar to Naturally occurring caries.
  3. Specific bacteria can be isolated and identified from plaque over various carious lesions.

Although the role of bacterial activity in the genesis of carious lesion is well defined, establishing a cause and effect relationship between individual organism in the oral flora and caries has not been completely successful.

Oral bacteria do not occur as solitary colonies but as members of the complex community of many species contained as a massive tightly packed cells held together by the sticky matrix of polymer glucose known as "Dextran".

 

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Reference:

Sturdvant's Art & Science of Operative Dentistry, 4th Edition.

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Yes you can

Paper 1

  1. Tooth Conservation
  2. Dental Caries
  3. Endodontics
  4. Dental Pulp
  5. Dental materials

Paper 2

  1. Fixed Prosthodontics
  2. Removable Prosthodontics
  3. Implantology

Paper 3

  1. Anaesthesia and Resuscitation
  2. Infection Control
  3. Medicine and Surgery
  4. Oral & Maxillofacial Surgery
  5. Oral Medicine
  6. Oral Pathology
  7. Pharmacology and Therapeutics

Paper 4

  1. Orthodontics
  2. Paediatric Dentistry
  3. Periodontics
  4. Preventive Dentistry
  5. Public Dental Health
  6. Radiology