Podcast
Questions and Answers
What clinical feature is typically associated with an apical abscess but not a periodontal abscess?
What clinical feature is typically associated with an apical abscess but not a periodontal abscess?
- Presence of a fistula or sinus tract (correct)
- Mobility of the tooth
- Deep pocket association
- Tenderness to percussion
A patient presents with a localized, ovoid elevation in the interdental papilla. Which condition is most likely?
A patient presents with a localized, ovoid elevation in the interdental papilla. Which condition is most likely?
- Periapical Granuloma
- Radicular Cyst
- Apical Abscess
- Gingival Abscess (correct)
Which special test is most useful in differentiating between an apical abscess and a periodontal abscess?
Which special test is most useful in differentiating between an apical abscess and a periodontal abscess?
- Percussion test
- Test for mobility
- Electric pulp test (correct)
- Palpation test
What is the primary difference in the origin of an apical abscess compared to a periodontal abscess?
What is the primary difference in the origin of an apical abscess compared to a periodontal abscess?
Which finding suggests a periodontal abscess rather than an apical abscess?
Which finding suggests a periodontal abscess rather than an apical abscess?
Which of the following characteristics is most indicative of a periodontal abscess rather than an apical abscess?
Which of the following characteristics is most indicative of a periodontal abscess rather than an apical abscess?
Which of the following is a consistent characteristic of both apical and periodontal abscesses?
Which of the following is a consistent characteristic of both apical and periodontal abscesses?
In the context of abscess formation, what is the body's primary objective through the inflammatory response?
In the context of abscess formation, what is the body's primary objective through the inflammatory response?
The presence of what is closely related to apical abscesses?
The presence of what is closely related to apical abscesses?
A patient presents with a localized swelling on the buccal gingiva, near the apex of tooth #25. The tooth is sensitive to percussion, and a periapical radiograph reveals a slight thickening of the periodontal ligament space. Which condition is MOST likely?
A patient presents with a localized swelling on the buccal gingiva, near the apex of tooth #25. The tooth is sensitive to percussion, and a periapical radiograph reveals a slight thickening of the periodontal ligament space. Which condition is MOST likely?
Which sign is more closely associated with periodontal abscesses?
Which sign is more closely associated with periodontal abscesses?
A patient complains of a painful, swollen area in their gums. Upon examination, you notice a deep pocket with pus draining around a tooth that has significant bone loss. The tooth is not particularly sensitive to percussion. Which condition is MOST likely?
A patient complains of a painful, swollen area in their gums. Upon examination, you notice a deep pocket with pus draining around a tooth that has significant bone loss. The tooth is not particularly sensitive to percussion. Which condition is MOST likely?
Which treatment approach would MOST directly address the underlying cause of an apical abscess?
Which treatment approach would MOST directly address the underlying cause of an apical abscess?
Why is it important to differentiate between an apical and periodontal abscess in a real world clinical setting?
Why is it important to differentiate between an apical and periodontal abscess in a real world clinical setting?
What is the MOST likely reason for prescribing systemic antibiotics in conjunction with local treatment for a dental abscess?
What is the MOST likely reason for prescribing systemic antibiotics in conjunction with local treatment for a dental abscess?
Which diagnostic method provides information about the extent of bone involvement in both apical and periodontal abscesses?
Which diagnostic method provides information about the extent of bone involvement in both apical and periodontal abscesses?
A patient presents with a history of periodontitis and associated abscess. What is the MOST likely diagnosis?
A patient presents with a history of periodontitis and associated abscess. What is the MOST likely diagnosis?
What clinical sign is commonly associated with both apical and periodontal abscesses?
What clinical sign is commonly associated with both apical and periodontal abscesses?
Which of the following extra-oral symptoms is MORE likely to be associated with an apical abscess than a periodontal abscess?
Which of the following extra-oral symptoms is MORE likely to be associated with an apical abscess than a periodontal abscess?
A patient has a history of a carious lesion and presents with a painful swelling near the apex of the tooth. Which condition is the MOST likely cause?
A patient has a history of a carious lesion and presents with a painful swelling near the apex of the tooth. Which condition is the MOST likely cause?
What historical dental information would lead you to suspect a periodontal abscess over an apical abscess?
What historical dental information would lead you to suspect a periodontal abscess over an apical abscess?
Which of the following signs and symptoms is LEAST likely to be associated with a periodontal abscess?
Which of the following signs and symptoms is LEAST likely to be associated with a periodontal abscess?
The presence of regional lymphadenopathy is a sign of infection. Which type of abscess is it associated with?
The presence of regional lymphadenopathy is a sign of infection. Which type of abscess is it associated with?
Pain can be a symptom of both apical and periodontal abscesses. What characteristic of the pain might suggest pulpitis?
Pain can be a symptom of both apical and periodontal abscesses. What characteristic of the pain might suggest pulpitis?
What conclusion can be drawn from the information about increased body temperature and malaise in relation to apical and periodontal abscesses?
What conclusion can be drawn from the information about increased body temperature and malaise in relation to apical and periodontal abscesses?
Which of the following microorganisms is typically found in high percentages (50-100%) in Viridans Streptococci?
Which of the following microorganisms is typically found in high percentages (50-100%) in Viridans Streptococci?
Which group of bacteria, characterized as a mix of facultative and strict anaerobic gram-negative species, is associated with apical and periodontal abscesses?
Which group of bacteria, characterized as a mix of facultative and strict anaerobic gram-negative species, is associated with apical and periodontal abscesses?
Which combination of microorganisms are commonly associated with apical and periodontal abscesses?
Which combination of microorganisms are commonly associated with apical and periodontal abscesses?
Which of the following is the primary cause of an apical abscess?
Which of the following is the primary cause of an apical abscess?
Trauma can lead to pulp necrosis and subsequent apical abscess formation. Which of the following scenarios is LEAST likely to cause this?
Trauma can lead to pulp necrosis and subsequent apical abscess formation. Which of the following scenarios is LEAST likely to cause this?
Which of the following characteristics best describes the microbial composition of apical and periodontal abscesses?
Which of the following characteristics best describes the microbial composition of apical and periodontal abscesses?
A patient presents with signs of an apical abscess. Besides clinical examination, which of the following is critical for diagnosis?
A patient presents with signs of an apical abscess. Besides clinical examination, which of the following is critical for diagnosis?
A periapical radiograph reveals a distinct radiolucency around the apex of a tooth. What does this finding most likely indicate?
A periapical radiograph reveals a distinct radiolucency around the apex of a tooth. What does this finding most likely indicate?
Which of the following factors is LEAST likely to contribute to the development of an apical abscess?
Which of the following factors is LEAST likely to contribute to the development of an apical abscess?
A patient is suspected of having an apical abscess. Which diagnostic approach is most comprehensive?
A patient is suspected of having an apical abscess. Which diagnostic approach is most comprehensive?
Which of the following species is least likely to be associated with periodontal infections?
Which of the following species is least likely to be associated with periodontal infections?
In the context of apical abscesses, what is the significance of lateral or accessory canals?
In the context of apical abscesses, what is the significance of lateral or accessory canals?
What shared characteristic do Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia possess that contributes to their role in periodontal disease?
What shared characteristic do Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia possess that contributes to their role in periodontal disease?
Dento-alveolar abscess is a term used to describe:
Dento-alveolar abscess is a term used to describe:
How does a periapical abscess differ from a periodontal abscess in terms of origin?
How does a periapical abscess differ from a periodontal abscess in terms of origin?
If a patient presents with symptoms suggestive of an apical abscess, but the pulp vitality test yields a positive result, what does this indicate?
If a patient presents with symptoms suggestive of an apical abscess, but the pulp vitality test yields a positive result, what does this indicate?
When diagnosing an apical abscess, what is the purpose of integrating the patient history, clinical examination, and special tests?
When diagnosing an apical abscess, what is the purpose of integrating the patient history, clinical examination, and special tests?
What is the primary difference between apical periodontitis and a periapical abscess?
What is the primary difference between apical periodontitis and a periapical abscess?
Following a traumatic injury to a tooth, what is the most critical factor that determines whether pulp necrosis will occur, leading to a periapical abscess?
Following a traumatic injury to a tooth, what is the most critical factor that determines whether pulp necrosis will occur, leading to a periapical abscess?
In managing apical abscesses, what is the primary goal of treatment beyond pain relief?
In managing apical abscesses, what is the primary goal of treatment beyond pain relief?
What bacteria are commonly involved in apical and periodontal abscesses?
What bacteria are commonly involved in apical and periodontal abscesses?
Flashcards
Dental Abscess
Dental Abscess
A localized collection of pus associated with a tooth.
Apical Abscess
Apical Abscess
An inflammatory reaction to pulpal infection and necrosis, characterized by rapid onset, pain, tenderness, pus formation and swelling.
Periodontal Abscess
Periodontal Abscess
A localized accumulation of pus within the gingival wall of a periodontal pocket, leading to tissue breakdown.
Purpose of Abscess Formation
Purpose of Abscess Formation
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Aetiology of Apical Abscess
Aetiology of Apical Abscess
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Location of a Periodontal Abscess
Location of a Periodontal Abscess
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Clinical presentation of Apical Abscess
Clinical presentation of Apical Abscess
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Hallmark of both Apical and Periodontal Abscess
Hallmark of both Apical and Periodontal Abscess
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Periapical Abscess
Periapical Abscess
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Dento-alveolar Abscess
Dento-alveolar Abscess
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Apical Periodontitis
Apical Periodontitis
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Alveolar Abscess
Alveolar Abscess
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Pulp Necrosis
Pulp Necrosis
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Bacterial Toxins
Bacterial Toxins
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Carious Lesion
Carious Lesion
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Dental Trauma
Dental Trauma
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Periodontal Abscess Swelling
Periodontal Abscess Swelling
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Percussion Sensitivity in Abscesses
Percussion Sensitivity in Abscesses
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Abscess Sinus Tracts
Abscess Sinus Tracts
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Tooth Mobility (Abscesses)
Tooth Mobility (Abscesses)
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Deep Pocket Association
Deep Pocket Association
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Deep Carious Lesions
Deep Carious Lesions
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Prior Root Canal Treatment (Abscesses)
Prior Root Canal Treatment (Abscesses)
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Microbiology of Abscesses
Microbiology of Abscesses
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Common Bacteria in Abscesses
Common Bacteria in Abscesses
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Diagnosis of Abscesses
Diagnosis of Abscesses
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History (Diagnosis)
History (Diagnosis)
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Clinical Examination (Diagnosis)
Clinical Examination (Diagnosis)
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Special Tests (Diagnosis)
Special Tests (Diagnosis)
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Hallmark Feature of Abscesses
Hallmark Feature of Abscesses
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Diagnosis in Dentistry
Diagnosis in Dentistry
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Pain in Abscesses
Pain in Abscesses
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Tenderness in Abscesses
Tenderness in Abscesses
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Swelling in Abscesses
Swelling in Abscesses
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Mobility in Abscesses
Mobility in Abscesses
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Abscess History
Abscess History
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Facial Swelling and Abscesses
Facial Swelling and Abscesses
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Fever and Abscesses
Fever and Abscesses
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Malaise and Abscesses
Malaise and Abscesses
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Lymph Nodes and Abscesses
Lymph Nodes and Abscesses
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Study Notes
- Framework for management of apical and periodontal abscess
Learning Outcomes
- Be able to Identify aetiology of apical and periodontal abscess
- Be able to Differentiate their clinical presentation
- Be able to Recognise care options to manage both conditions
Dental Abscess
- Localised pus collection associated with a tooth
Inflammatory Response
- Outcomes of OB interaction with S. aureus:
- Altered RANKL:OPG axis
- Increased OB cytokine production
- OB cell death (apoptosis, necrosis)
- Outcomes of OC interaction with S. aureus:
- Enhanced bone resorption
- Increased OC survival
- Increased OC activity
Apical Abscess Definition
- An inflammatory reaction to pulpal infection and necrosis
- Characterised by rapid onset
- Spontaneous pain
- Tenderness of the tooth to pressure
- Pus formation
- Swelling of associated tissues
Periodontal Abscess Definition
- Localised accumulation of pus located within the gingival wall of the periodontal pocket/sulcus
- Results in significant tissue breakdown
Terminology
- Apical Abscess
- Periapical Abscess
- Dento-alveolar Abscess
- "Apical Periodontitis"
- "Alveolar Abscess"
Apical (Periapical, Dento-alveolar) Abscess Aetiology
- Pulp Necrosis (death)
- Bacterial invasion & toxins from carious lesion
- Trauma - impact / fracture
- Trauma - restorative procedures
- Trauma - restorative materials
- Trauma - occlusion
- Bacteria invasion from lateral / accessory canals
Microbiology
- Mix of facultative and strict anaerobic Gram-negative bacteria present
- Viridans Streptococci
- Porphyromonas gingivalis (50-100%)
- Prevotella intermedia
- Prevotella melaninogenica
- Fusobacterium nucleatum
- Tannerella forsythia
- Treponema species
- Campylobacter species
- Capnocytophaga species
- Aggregatibacter actinomycetemcomitans gram-negative enteric rods
Diagnosis
- History
- Clinical Examination
- Special Test
- Radiological Examination
History
- Apical Abscess:
- Carious lesion
- Restoration
- History of previous abscess
- Periodontal Abscess:
- History of periodontitis
- Periodontal treatment
- Previous abscess
Extra Oral Clinical Examination
- Apical Abscess:
- Possible facial swelling
- Possible increase in body temperature
- Possible malaise
- Regional lymphadenopathy (possible)
- Periodontal Abscess:
- Rare facial swelling
- Possible increase in body temperature
- Possible malaise
- Regional lymphadenopathy
Intra Oral Clinical Examination
- Apical Abscess:
- Lobulated swelling located at root apex / sulcus region
- Tender to percussion
- Tender to sulcus palpation
- Fluctuant
- Periodontal Abscess:
- Localised ovoid elevation in the marginal gingiva and/or interdental papilla
- Tender to percussion
- Fluctuant
Intra Oral Clinical Examination
- Apical Abscess:
- Possible Deep carious lesion / restorations / Poor restorative margin seal.
- Periodontal Abscess:
- Bleeding on probing
- Suppuration on probing
- Fistula or sinus
- Mobility of tooth
- Deep pocket association
Special Tests
- Apical Abscess:
- Thermal Test (?)
- Electric Pulp Test (?)
- Periodontal Abscess:
- Thermal Test (+)
- Electric Pulp Test (?)
Radiological Examination
- Periapical view to assess: Apical Abscess, Periodontal Abscess
- Bitewing:
- Is not used for adult patients
- Is (?) used for Paediatric patients
Management Options
- Apical Abscess:
- Analgesics
- Warm Salt Rinse
- Drain abscess / swelling
- Endodontic treatment
- Extraction
- Periodontal Abscess:
- Analgesics
- Warm Salt Rinse
- Drain abscess / swelling
- Periodontal treatment
- Extraction
- Antibiotic is required if there is spread of infection or systemic involvement (seek Dentist or General Medical Practitioner)
- Arrange follow up appointment with Dentist for definitive care plan
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