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PERIODONTAL ABSCESS
Presented byDr. Guru Ram Tej KII yr Post Graduate
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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
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INTRODUCTION
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DEFINITION
International conference on research in
biology of periodontal disease 1977
Carranza 1990
Hafstrom 1994
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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%
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CLASSIFICATION
Based on duration Based on number Based on location
Based on etiology Periodontitis related Non- periodontitis related
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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)
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Four types of abscess associated with periodontal tissues
Gingival abscess Peri-coronal abscess Combined periodontal/ endodontic Lateral Periodontal abscess
{Periodontal abscess: A review Punit Vaibhav Patel, Sheela Kumar G, Amrita Patel}
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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)
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ETIOLOGY OF PERIODONTAL ABSCESS
Etiology
Environmental factors
Microbiological factors
Other local factors
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ENVIRONMENTAL FACTORS
Pre existing pocket
Major factor
Deeper, narrower, tortuous
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MICROBIOLOGY
Anaerobes (Newman& Sims) P. gingivalis- 50-100%(Topoll et al in 1990)
Periodontal pathogens usually isolated from periodontal abscess
F nucleatumB forsythusP gingivalisP intermedia
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Herrera et al in 2000- 45% anaerobes resembles periodontitis microbiota
Polymicrobial, non motile, gram negative, rod shaped anaerobes
Ashimoto et al- P gingivalisOther microbes include
P intermedia P melaninogenica F nucleatum B forsythus Spirochetes
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VIRUSES IN PERIODONTAL ABSCESS
Saygun et al in 2004- CMV and EBV1
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OTHER LOCAL FACTORS
Foreign material such as1. Pop-corn husk2. Impacted food3. Fish bone4. Tooth brush bristles5. Irrigating devices
ANACHORETIC EFFECT
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DIABETES AND PERIODONTAL ABSCESS
Low host resistance Decreased chemotaxis/ phagocytosis Altered collagen metabolim
PATHOGENESIS
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Trauma to the orifice of the periodontal pocket
Destruction of connective tissues
Formation of infiltrate
Entry of bacteria into soft tissue wall
Decreased tissue resistance
Pus formation
Virulence and number of bacteria
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HISTOPATHOLOGY
De Witt et al in 1985
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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)
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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
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Herrera et al in 2000- blood and urine
samples- reported 30%- elevated leukocytes
and 20-40% neutrophils and monocytes
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DIFFERENTIAL DIAGNOSIS
Peri apical abscess
Manifestation of systemic disease
Incomplete tooth fracture
Pericoronitis
Periodontal cysts
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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
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Draining the abscess with digital pressure
Incision and drainage (Ahl et al 1986)
Scaling and root planing
THE MANAGEMENT OF THE ACUTE LESION
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THE APPROPRIATE TREATMENT OF THE ORIGINAL AND/OR RESIDUAL LESION
Periodontal surgeryThe use of different systemically administered
antibiotics, and Tooth extraction.
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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
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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
28CASE REPORT BY KRITHIKA ET AL IN 2011
CLENCHING ABSCESS
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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
Talia Becker and Alex Neronov in 2012
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CONCLUSION
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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) - Journal of Dental Research 77; 854-858.
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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
Thank you…