Periodontal abscess

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abscesses effecting the periodontium associated with tooth loss

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Periodontal abscess

  1. 1. PERIODONTAL ABSCESS 1 Presented by Dr. Guru Ram Tej K II yr Post Graduate
  2. 2. CONTENTS             INTRODUCTION DEFINITION AND PREVALENCE CLASSIFICATION ETIOLOGY OF PERIODONTAL ABSCESS MICROBIOLOGY PATHOGENESIS AND HISTOPATHOLOGY CLINICAL FEATURES DIAGNOSIS DIFFERENTIAL DIAGNOSIS MANAGEMENT OF PERIODONTAL ABSCESS CONCLUSION REFERENCES 2
  3. 3. INTRODUCTION 3
  4. 4. DEFINITION  International conference on research in biology of periodontal disease 1977  Carranza 1990  Hafstrom 1994 4
  5. 5. PREVALENCE 3rd most frequent dental emergency  Representing 7-14%  Affecting 6-7%  Effects prognosis of tooth  Gray et al 1994- 27.5% and 59.5%  Mc Leod et al 1997- 37%  5
  6. 6. CLASSIFICATION Based on duration  Based on number  Based on location   Based on etiology  Periodontitis related  Non- periodontitis related 6
  7. 7. PERIODONTITIS RELATED ABSCESS Active periodontal destruction  Exacerbation of a chronic lesion  Post therapy periodontal abscess  Post scaling  Post surgery  Post antibiotic(Topoll in 1990) (Helevou et al in 1993-broad spectrum antibiotics)  7
  8. 8.  Four types of abscess associated with periodontal tissues  Gingival abscess  Peri-coronal abscess  Combined periodontal/ endodontic  Lateral Periodontal abscess 8 {Periodontal abscess: A review Punit Vaibhav Patel, Sheela Kumar G, Amrita Patel}
  9. 9. NON PERIODONTITIS RELATED ABSCESS Impaction of foreign body  Orthodontic devices   Root morphology alterations  Invaginated root(Chen et al in 1990)  Fissured root(Goose 1981)  Root tears(Haney et al 1992)  Endodontic perforations(Abrams et al 1992) 9
  10. 10. ETIOLOGY OF PERIODONTAL ABSCESS Etiology Environmental factors Microbiological factors Other local factors 10
  11. 11. ENVIRONMENTAL FACTORS  Pocket  Pre existing pocket  Major factor  Deeper, narrower, tortuous 11
  12. 12. MICROBIOLOGY Anaerobes (Newman& Sims)  P. gingivalis- 50-100%(Topoll et al in 1990)  F nucleatum B forsythus P gingivalis P intermedia Periodontal pathogens usually isolated from periodontal abscess 12
  13. 13. Herrera et al in 2000- 45% anaerobes resembles periodontitis microbiota  Polymicrobial, non motile, gram negative, rod shaped anaerobes  Ashimoto et al- P gingivalis Other microbes include  P intermedia  P melaninogenica  F nucleatum  B forsythus  Spirochetes  13
  14. 14. VIRUSES IN PERIODONTAL ABSCESS  Saygun et al in 2004- CMV and EBV1 14
  15. 15. OTHER LOCAL FACTORS  Foreign material such as 1. Pop-corn husk 2. Impacted food 3. Fish bone 4. Tooth brush bristles 5. Irrigating devices  ANACHORETIC EFFECT 15
  16. 16. DIABETES AND PERIODONTAL ABSCESS  Low host resistance  Decreased chemotaxis/ phagocytosis  Altered collagen metabolim 16
  17. 17. PATHOGENESIS Entry of bacteria into soft tissue wall Trauma to the orifice of the periodontal pocket Formation of infiltrate Destruction of connective tissues Pus formation Decreased tissue resistance Virulence and number of bacteria 17
  18. 18. HISTOPATHOLOGY  De Witt et al in 1985 18
  19. 19. CLINICAL FEATURES AND DIAGNOSIS Acute Abscess  Localized red, ovoid swelling  Periodontal pocket  Mobility  Tooth elevation in socket  Tenderness to percussion or biting  Exudation  Elevated temperature  Regional lymphadenopathy (Smith and Davies „86) 19
  20. 20. Chronic Abscess  No pain or dull pain  Localized inflammatory lesion  Slight tooth elevation  Intermittent exudation  Fistulous tract often associated with a deep pocket  Usually without systemic involvement 20
  21. 21.  Herrera et al in 2000- blood and urine samples- reported 30%- elevated leukocytes and 20-40% neutrophils and monocytes 21
  22. 22. DIFFERENTIAL DIAGNOSIS  Peri apical abscess  Manifestation of systemic disease  Incomplete tooth fracture  Pericoronitis  Periodontal cysts 22
  23. 23. MANAGEMENT OF PERIODONTAL ABSCESS  The treatment of the periodontal abscess usually includes two stages: (1) The management of the acute lesion, and (2) The appropriate treatment of the original and/or residual lesion, once the emergency situation has been controlled 23
  24. 24. THE MANAGEMENT OF THE ACUTE LESION Draining the abscess with digital pressure Incision and drainage (Ahl et al 1986) Scaling and root planing 24
  25. 25. THE APPROPRIATE TREATMENT OF THE ORIGINAL AND/OR RESIDUAL LESION Periodontal surgery The use of different systemically administered antibiotics, and Tooth extraction. 25
  26. 26. ANTIBIOTICS Antibiotic Options for Periodontal Infections1 Antibiotic of Choice  Amoxicillin, 500 mg  1.0-g loading dose, then 500 mg tid, 3 days Penicillin Allergy  Clindamycin 600-mg loading dose, then 300 mg qid, 3 days  Azithromycin (or clarithromycin)  1.0-g loading dose, then 500 mg qid, 3 days 26
  27. 27.  Smith and Davies in 1986- metranidazole (200mg tid 5days)  Herrera et al in 1994- tetracycline therapy  There was a rapid control of pain levels, reduction in edema, redness and swelling, periodontal probing depth were significantly reduced.  Gingivectomy  Surgical flaps 27
  28. 28. CLENCHING ABSCESS 28 CASE REPORT BY KRITHIKA ET AL IN 2011
  29. 29. RECENT STUDIES If untreated the periodontal abscess may lead to cervicofacial necrotizing fasciitis Medeiros et al 2012  Orthodontic Elastic Separator-Induced periodontal Abscess: A Case Report  29 Talia Becker and Alex Neronov in 2012
  30. 30. CONCLUSION 30
  31. 31. REFERENCES Newman, Takei, Klokkevld, Carranza,; Carranza‟s clinical periodontology. 10th Ed. 714  Jan Lindhe, Niklaus P Lang, T Karring; Clinical periodontology and implant dentistry 5th ed  “Periodontal Abscess”- A Review - (2000) Herrera. D, Journal of Clinical Periodontology: 27; 377-387.  “Periodontal Abscess” etiology and classification-(1999)Meng H. - Annals of Periodontology;79-82  “Predominant Cultivable Microbiota”- Newman et al.(1979).Journal of Periodontology;27;350-354  Ashimoto. PCR detection of Periodontal/ endodontal pathogens associated with abscess formation (1998) - 31 Journal of Dental Research 77; 854-858. 
  32. 32.  Topoll HH, Lange DE and Miller RF: Multiple periodontal abscesses after systemic antibiotic therapy. J Clin Periodontol 1990; 17: 268-272.  Krithiga Gurumoorthy, Babitha Ajjappa, Shobha Prakash; multiple acute periodontal abscesses due to clenching.: Journal of Interdisciplinary Dentistry / Jan-Jun 2011 / Vol-1 / Issue-1  Saygun I, Yapar M, ozdemir A, Kubar A, Slots J. Human cytomegalo virus and Ebstien Barr virus type 1 in periodontal abscesses: oral microbiol Immunol 2004: 19: 83-87  Cervicofacial necrotizing fasciitis following periodontal abscess. Medeiros Junior, Rui De Sousa Catunda, IvsonVieira Queiroz, Isaac Henrique Araujo de Morais, Hecio Carneiro Leao, Jair Alcino Monteiro Gueiros, Luiz: general dentistry jul/aug 2012. Vol 60 issue 4, 316-321  Norhidayah, Khamiza What Expert Says … Periodontal Abscess Malaysian Dental Journal (2008) 29(2) 154-157  Obradović R. Radmila, Kojović B. Draginja, Branković R. Vesna: The Therapy Of Periodontal Abscess: Acta Stomatologica Naissi, Jun/June 2008, Vol. 24, Broj/Number 57.  Talia Becker and Alex Neronov: Orthodontic Elastic Separator-Induced Periodontal Abscess: A Case Report; case reports in dentistry 2012 32
  33. 33. Thank you…

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