W10-treatment of acute periodontal conditions.pdf

5.12.2023 PERIODONTOLOGY Treatment of Acute Gingival/ Periodontal Conditions Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources Newman and Carranza’s Clinical Periodontology 2 1 5.12.2023 Acute periodontal/gingival conditions • Necrotizing Ul...

5.12.2023 PERIODONTOLOGY Treatment of Acute Gingival/ Periodontal Conditions Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources Newman and Carranza’s Clinical Periodontology 2 1 5.12.2023 Acute periodontal/gingival conditions • Necrotizing Ulcerative Gingivitis • Primary Herpetic Gingivostomatitis • Pericoronitis • Periodontal abscess 3 Necrotizing Ulcerative Gingivitis 4 2 5.12.2023 Necrotizing Ulcerative Gingivitis 5 Necrotizing Ulcerative Gingivitis Treatment Ease the acute symptoms Easier! Correction of the underlying chronic gingival or periodontal disease Requieres more conprehensive prosedures Follow up Patient education 6 3 5.12.2023 Treatment of NG 1) Alleviation of the acute inflammation by reduction of the microbial load and removal of necrotic tissue 2) Treatment of chronic disease either underlying the acute involvement or elsewhere in the oral cavity 3) Alleviation of generalized symptoms such as fever and malaise 4) Correction of systemic conditions or factors that contribute to the initiation or progression of gingival changes. 7 Treatment of NG : 1st Visit Comprehensive evaluation: Ø Thorough medical history • Recent ilness • Living conditions • Dietary background • Smoking • Type of employement • Hours of rest • Risk factors for HIV • Pyschosocial parameters (stress, depression) 8 4 5.12.2023 Treatment of NG : 1st Visit Physical examination: v assessment of general appearance, v presence of halitosis, v presence of skin lesions, v vital signs à temperature v palpation for the presence of enlarged lymph nodes (esp. submaxillary and submental nodes) 9 Treatment of NG : 1st Visit Oral examination: v Examine for the characteristic NUG lesions v Distribution, v Possible involvement of the oropharyngeal region. v Oral hygiene v Presence of pericoronal flaps, v Periodontal pockets v Local risk factors (e.g., poorly contoured and ill-fitting restorations, presence and distribution of calculus). Periodontal probing of NUG lesions is likely to be very painful, will not aid in the primary diagnosis, and may need to be deferred until after the acute lesions are resolved. 10 5 5.12.2023 Treatment of NG : 1st Visit The goals of initial therapy: • • microbial load necrotic tissue à Repair Regeneration Normal tissue barrier 11 Treatment of NG : 1st Visit v Superficial calculus removal (ultrasonics are useful) v Subgingival scaling and curretage Ø Extend the infection to deeper tissues Ø Bacteremia ANTIBIOTICS???? à Systemic complications 👍 12 6 5.12.2023 Treatment of NG : 1st Visit Instructions to the Patient 1.Avoid tobacco, alcohol, and condiments. 2.Rinse with a glassful of an equal mixture of 3% hydrogen peroxide and warm water every 2 hours and/or 0.12% chlorhexidine solution twice daily. 3.Get adequate rest. Pursue usual activities, but avoid excessive physical exertion or prolonged exposure to the sun, as in golfing, playing tennis, swimming, or sunbathing. 13 Treatment of NG : 1st Visit Instructions to the Patient : 4. Confine toothbrushing to removal of surface debris with either a bland dentifrice or just water and an ultrasoft brush; overzealous brushing and the use of dental floss or interdental cleaners will be painful. Chlorhexidine mouth rinses are also helpful in controlling biofilm throughout the mouth. 5. An analgesic, such as a nonsteroidal antiinflammatory drug (NSAID; e.g., ibuprofen), is appropriate for pain relief. 6. Patients who have systemic complications such as high fever, malaise, anorexia, or general debility are given antibiotics and instructed to get plenty of bed rest and drink lots of fluids. 14 7 5.12.2023 Treatment of NG : 2nd Visit v 1 or 2 days later v Evaluate sign and symptoms (aveliation?) v Scaling (necessary - sensitivity permits). v Shrinkage of the gingiva à expose previously covered calculus v Instructions! 15 Treatment of NG : 3rd Visit v 5 days after 2nd visit v Evaluationà resolution of symptoms? v Comprehensive plan à solve periodontal condition v Biofilm control instructions v Nutrition, smoking etc instructions v Stop H2O2 rinse (CHX may be used for 2-3 weeks) v SCRP (if necessary) 16 8 5.12.2023 Treatment of NG 17 Treatment of NG :Gingival changes with healing 18 9 5.12.2023 Additional Treatment Considerations v Contouring of the gingiva: Usually heals with normal contour If not à periodontal plastic procedures /gingivoplasty v Drugs: !No drug, when used alone, can be considered complete treatment. local therapy and elimination of risk factors are essential for complete resolution. Amoxicillin 500 mg 4X1 (10 days) Metronidazol 500 mg 2X1 (7 days) 19 Primary Herpetic Gingivostomatitis Mainly children 7-10 days Heals without scarring EARLY DIAGNOSIS Immediate initiation of antiviral therapy 20 10 5.12.2023 Primary Herpetic Gingivostomatitis v Palliative care v Antiviral therapy (Acyclovir 15mg/kg 5x1 7 days) v Analgezics (NSAID-Ibuprufen) à relief v Topical anesthetics may be used 21 Pericoronitis • Mostly mandibular 3rd molars • Treatment depends on: - Position - Quality of surrounding tissue - severity of the inflammation - Presence and/or risk of systemic complications - Advisability of retaining the involved tooth. 22 11 5.12.2023 Pericoronitis Initial treatment: 1. Gently flush the area 2. Swab with antiseptic after the pericoronal flap has been lifted gently away from the tooth with an instrument 3. Remove underlying debris 4. Evaluate occlusion 23 Pericoronitis Evaluate occlusion: Opposing tooth contact! v Surgical removal may be needed Antibiotics?? - In severe cases? Swollen and fluctuant pericoronal flap - Drainage 24 12 5.12.2023 Pericoronitis Evaluate the prognosis (after acute symptoms relieved) - Persistent? - Bone loss (distal of #7) EXTRACTION??? - Quality of tissues Risk of bone loss is greater à #8 are extracted after To reduce the risk of bone loss à partially or completely impacted third molars should be the roots are formed or patient is older extracted early in their development. 25 Thank you for listening…. 26 13