Apical And Periodontal Abscess GN PDF

In partnership with Apical & Periodontal Abscess Jiann Khaw Tutor Dentist  A framework for management of The Apical and Aim Periodontal abscess 2 Learning Outcomes: At the end of this session, you should be able to: 1. Identify aetiolo...

In partnership with Apical & Periodontal Abscess Jiann Khaw Tutor Dentist  A framework for management of The Apical and Aim Periodontal abscess 2 Learning Outcomes: At the end of this session, you should be able to: 1. Identify aetiology of apical and periodontal abscess 2. Differentiate their clinical presentation 3. Recognise care options to manage both conditions GDC Learning Outcome: 1.1.2, 1.1.4, 1.2.4, 1.7.8, 1.9.1 C1.1, C1.2, C1.4, C1.15, C1.17, C1.30,, C2.1.2, C2.1.4, C2.1.8, C2.4.2 3 Apical & Periodontal Abscess Ae#ology and Classi/ca#on 4 Image source: Dr. Jeremy Skepper, Wellcome Collection  Dental Abscess Localised pus collection associated to tooth DEAD TISSUE and WHITE BLOOD CELLS ACCULIMATED 5 Image source: J. Khaw  Inflammatory Response What do you think the body is trying to achieve Image source: Brandt et al (2018) with abscess forma#on? 6  Localised to periodontal tissue Definition Normally doesn’t involve tooth pulp Involved PDL, alveolar bone, periodontal tissues Apical Abscess Periodontal Abscess An inflammatory reaction to A periodontal abscess is a pulpal infection and necrosis localised accumulation of characterised by rapid onset, pus located within the spontaneous pain, tenderness gingival wall of the of the tooth to pressure, pus periodontal pocket/sulcus, formation, and swelling of resulting in a significant associated tissues. tissue breakdown. Normally due to caries American Association Jepsen, S. (2019) New of Endodontist (2009) Classification report 03. Consensus of Systemic and Other recommended Periodontal Condition, diagnostic terminology Guidance for Clinicians. European Federation of Periodontology: Spain. 7 Terminology Apical Abscess Periapical Abscess Image source: Berkovitz et al. (2018) Dento-alveolar Abscess “Apical Periodontitis” “Alveolar Abscess” Periapical radiograph showing (arrow) apical radiolucency on distal root of LR7 suggesting loss of bone due to abscess resulting from open carious lesion to pulp 8 Apical (Periapical, Dento-alveolar) Abscess Aetiology Pulp Necrosis (death) 1. Bacterial invasion & toxins from carious lesion 2. Trauma - impact / fracture 3. Trauma - restorative procedures 4. Trauma - restorative materials 5. Trauma - occlusion 6. Bacteria invasion from lateral / accessory canals Image source: Berman, L & Hargreaves, K (2020) Cohen's Pathway of the Pulp, 12th Edition. 9 10 Periodontal Abscess Jepsen, S. (2019) New Classification report 03. Systemic and Other Periodontal Condition, Guidance for Clinicians. European Federation of Periodontology: Spain. 11 12  Mainly gram — Viridans Streptococci Porphyromonas gingivalis (50‐100%) Prevotella intermedia Prevotella melaninogenica Photostockeditor Image source: Fusobacterium nucleatum Tannerella forsythia Treponema species Campylobacter species Capnocytophaga species Microbiology Aggrega?bacter ac?nomycetemcomitans gram‐ nega#ve enteric rods Mix of faculta#ve and strict anaerobic Gram-nega#ve Hererra et al. (2018) 13 Apical & Periodontal Abscess Clinical Presenta#on 14 Image source: Dr. Jeremy Skepper, Wellcome Collection Diagnosis History Clinical Examination Special Test Gopikrishna et al. (2009) Assessment of pulp vitality: a review, Int J Paed Dent, 19, pp. 3-15. Radiological Examination 15  Dull ache due to unmyelinated nerves being more apical Diagnosis History Clinical Examination History / Symptoms Apical Abscess Periodontal Abscess Special Test Pain (if pulp is vital) ✔ ✔ Radiological Examination Tenderness (touch, occlusion) ✔ ✔ Swelling ✔ ✔ Mobility of tooth ✔ ✔ Previous dental history carious lesion, restoration, history of periodontitis, history of previous abscess periodontal treatment, previous abscess If abscess is significant, can destroy alveolar bone and cause mobility Think about how pain symptoms are related to pulpitis? 16 Diagnosis History Clinical ExaminationExtra-Oral Apical Abscess Periodontal Abscess Special Test Facial swelling Possible Rare Radiological Examination Increase body temperature Possible Possible Malaise Possible Possible Regional lymphadenopathy ✔ ✔ Image "Sloth" by Spider.Dog is licensedunder source: CC BY 2.0 17 Diagnosis History Clinical ExaminationIntra-Oral Apical Abscess Periodontal Abscess Special Test Clinical presentation Radiological Examination Image sources: Apical: Soames & Southam (2018) Oral Pathology. 5 th Edn. Periodontal: Herrera et al. (2014) Acute Periodontal Lesion. Periodontology 2000 (65): 149-177. Visual description Lobulated swelling located Localised ovoid elevation at root apex / sulcus region in marginal gingiva and/or interdental papilla Tender to percussion ✔ ✔ Tender to sulcus palpation ✔ ? Fluctuant ✔ ✔ 18 Diagnosis History Clinical ExaminationIntra-Oral Apical Abscess Periodontal Abscess Special Test Bleeding on probing ? ✔ Radiological Examination Suppuration on probing ? ✔ ✔ Fistula or sinus Opening for pus to come out within swelling ✘ Mobility of tooth ✔ ✔ Deep pocket association ✘ ✔ Deep carious lesion / ✔ ✘ restorations / Poor restorative margin seal Previous endodontic Possible ✘ treatment (or Root Canal Treatment) 19 Diagnosis History Clinical Examination Special Test Special Tests Apical Abscess Periodontal Abscess Radiological Examination Thermal ? ✚ Electric Pulp Test ? ? Think about why electric pulp test may not be relevant in multi-rooted 20 tooth?  No justification to take radiograph for periodontal abscess Diagnosis Soft tissue related History Clinical Examination Radiographic view Apical Abscess Periodontal Abscess Special Test Periapical Radiological Examination Bitewing ✘For adult patients ? Paediatric patients Think about suitability of 21 DPT? Apical & Periodontal Abscess Management op#ons 22 Image source: Dr. Jeremy Skepper, Wellcome Collection Management Options Care options Apical Abscess Periodontal Abscess Analgesics ✔ ✔ Warm Salt Rinse ✔ ✔ Drain abscess / swelling ✔ ✔ Periodontal treatment ✘ ✔ Endodontic 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 de^nitive care plan 23  Background Dental pain can have a detrimental e0ect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with these conditions should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, di0use swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies within both the individual and the community. This review is an update of the original version that was published in 2014. 24  Signs & Aetiology Symptoms Abscess Care Summary options Diagnosis Link to: Decision on care options Inflammatory response Symptoms of pulpitis Radiographic view Adaptation of diagram by S.Balian (2021) 25 Bibliography for this presenta=on: 1. American Association of Endodontist (2009) AAE Consensus Conference Recommended Diagnostic Terminology. JOE, 35 (12):1634. Available at: https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/aaeconsensusconferencerecom mendeddiagnosticterminology.pdf (Accessed: 7 January 2025). 2. Brandt, S.L., Putnam, N.E., Cassat, J.E. and Serezani, C.H. (2018) Innate Immunity to Staphylococcus aureus: Evolving Paradigms in Soft Tissue and Invasive Infections. J Immunol, 200, pp. 3871-3880 DOI: 10.4049/jimmunol.1701574 3. Cope, A.L., Francis, N., Wood, F. and Chestnutt, I.G. (2018) Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD010136. DOI: 10.1002/14651858.CD010136.pub3. 4. Herrera, D., Retamal-Valdes, B., Alonso, B. and Feres, M. (2018). Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. Journal of clinical periodontology, 45 Suppl 20, S78–S94. DOI: 10.1111/jcpe.12941 5. Jepsen, S. (2019) New Classification report 03. Systemic and Other Periodontal Condition, Guidance for Clinicians. European Federation of Periodontology: Spain. Available at: https://www.efp.org/fileadmin/uploads/efp/Documents/Campaigns/New_Classification/Guidance_N otes/report-03.pdf (Accessed: 7 January 2025). 26