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  1. 1. PeriodontitisAcute periodontitis Acute inflammation of the perodontal ligament gradually involving the whole periodontiumCauses (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
  2. 2. Clinical featuresToothachePatient feels that the tooth is extrudedFeverMalaiseEnlarged cervical LN Dr S Chakradhar 4
  3. 3. 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
  4. 4. Periapical abscess Usually a progression of periodontitis History  Severe throbbing pain  Tenderness  Diffuse swelling  Fever
  5. 5. On examination Inability to occlude Fluctuant swelling in buccal or lingual region Sensitive to percussion Mobility X ray may show periapical radiolucency
  6. 6. Management Incision and drainage Don’t give local infiltration as chances of dissemination of infection is there Antibiotic coverage Analgesic Maintenance of oral hygiene
  7. 7. 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
  8. 8. 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
  9. 9. ManagementMaintain oral hygiene Brushing Mouth washScaling to remove plaque and calculiSubgingival curettage of pocket, to allownormal reattachment of gingival andperiodontal tissueMucogingival flap operation: curettage ofgranulation tissue, dead bone andcementum beneath a flap of gingiva
  10. 10. Complications Intraoral and extraoral abscess Maxillary sinusitis Ostemyelitis of jaw Cellulitis of face Dissemination of infection: bacteremia, septicemia
  11. 11. 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 3 rd molar at the age of 18 to 25 yrs But any tooth can be affected
  12. 12. 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
  13. 13. Clinical features Pain Swollen operculum Trismus Halitosis Fever and enlarged cervical LN Purulent exudate Abscess formation
  14. 14. 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 daysOr Erythromycin 250mg qid for 5 to 7 days Operculectomy Removal of upper tooth may be necessary