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Diagnosis and Treatment of Periodontal Emergencies

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Diagnosis and Treatment of Periodontal Emergencies PERIODONTAL Dr. Nazli Rabienejad DDS,MSc; Periodontist Assistant professor of Hamadan Dentistry faculty viral shedding may begin 5–6 days before the appearance of the first symptoms. Pre symptomatic carriers are difficult to identify viral load is shown to be the highest at the time of symptom onset any person who enters may be a potential source of transmission Dr. Nazli Rabienejad 3 Dr. Nazli Rabienejad 4 Dr. Nazli Rabienejad 5 انتقال حین درمان های دندانپزشکی دراپلت بزاقی دراپلت تنفسی آئروسل Dr. Nazli Rabienejad موارد اورژانس و ضروری در ارائه خدمات دندانپزشکی در شرایط همه گیری کووید19- تسکین درد کنترل خونریزی بیمار خطر برای کنترل عفونت سﻻمتی Dr. Nazli Rabienejad 7 Dr. Nazli Rabienejad Dr. Nazli Rabienejad Dr. Nazli Rabienejad PERIODONTAL EMERGENCIES 1. Pericoronitis 2. Periodontal and gingival abscess 3. Chemical and physical injuries 4. Acute herpetic gingivostomatitis 5. Necrotizing ulcerative gingivitis 6. Cracked tooth syndrome 7. Periodontic and endodontic problems 8. Dentine hypersensitivity Dr. Nazli Rabienejad 11 Classification of Abscesses • marginal gingival and interdental tissues gingival abscess • periodontal pocket periodontal abscess • crown of a partially erupted tooth. Pericoronal abscess Dr. Nazli Rabienejad 12 Pericoronal Abscess (pericoronitis) • Most common periodontal emergency • inflammation of the soft tissue operculum, which covers a partially erupted tooth. • most often observed around the mandibular third molars Dr. Nazli Rabienejad 13 The clinical picture of pericoronitis • red, swollen, possibly suppurative lesion that is extremely painful to touch. • Swelling of the cheek at the angle of jaw, partial trismus, and radiating pain to ear and systemic complications such as fever, leukocytosis and general malaise are common findings. Dr. Nazli Rabienejad 14 Acute Pericoronitis treatment (1) gently flushing the area with warm water to remove debris and exudate (2) swabbing with antiseptic after elevating the flap gently from the tooth with a scaler Dr. Nazli Rabienejad 15 aimed at management of the acute phase, followed by resolution of the chronic condition • reduce soft tissue surgically • and/or to adjust the opposing tooth to alleviate pain • Incision to drainage • Bone loss on the distal surface of the second molar is a concern Dr. Nazli Rabienejad 16 Pericoronal Abscess • anesthetized • gently lifting the soft tissue operculum with a periodontal probe or curette. • If there is regional swelling, lymphadenopathy, or systemic signs, systemic antibiotics may be prescribed. • rinse with warm salt water every 2 hours, and the area is reassessed after 24 hours • surgical excision of the overlying tissue or removal of the offending tooth. Dr. Nazli Rabienejad 17 Gingival Abscess localized, acute inflammatory lesion microbial plaque infection, trauma, and foreign body impaction red, smooth, sometimes painful, often fluctuant swelling Dr. Nazli Rabienejad 18 Treatment of Gingival Abscess • topical or local anesthesia • is incised with a No. 15 scalpel blade • exudate may be expressed by gentle digital pressure • Any foreign material (e.g., dental floss, impression material) is removed • The area is irrigated with warm water and covered with moist gauze under light pressure. Dr. Nazli Rabienejad 19 Treatment of Gingival Abscess • rinse with warm salt water every 2 hours for the remainder of the day • After 24 hours the area is reassessed • If resolution is sufficient, scaling not previously completed is undertaken • If the residual lesion is large or poorly accessible, surgical access may be required Dr. Nazli Rabienejad 20 Dr. Nazli Rabienejad 21 Periodontal Abscess • Untreated periodontitis and in association with moderate-to-deep periodontal pockets • acute exacerbation of a preexisting pocket • incomplete calculus removal, after periodontal surgery, after preventive maintenance, after receiving systemic antibiotic therapy, result of recurrent disease • tooth perforation or fracture and foreign body impaction • Poorly controlled diabetes mellitus: predisposing factor for periodontal abscess formation Dr. Nazli Rabienejad 22 Dr. Nazli Rabienejad 23 Dr. Nazli Rabienejad 24 Periodontal Versus Pulpal Abscess Dr. Nazli Rabienejad 25 Dr. Nazli Rabienejad 26 Drainage through Periodontal Pocket • anesthetized with sufficient topical and local anesthetic • pocket wall is gently retracted with a periodontal probe or curette • Gentle digital pressure and irrigation • If the lesion is small and access uncomplicated, debridement in the form of scaling and root planning may be undertaken. • If the lesion is large and drainage cannot be established, root debridement by scaling and root planing or surgical access should be delayed until the major clinical signs have abated • adjunctive systemic antibiotics with short-term high-dose regimens Dr. Nazli Rabienejad 27 Dr. Nazli Rabienejad 28 Drainage through External Incision • vertical incision through the most fluctuant center of the abscess is made with a No. 15 surgical blade • separated with a curette or periosteal elevator • wound edges approximated under light digital pressure with a moist gauze pad. Dr. Nazli Rabienejad 29 Dr. Nazli Rabienejad 30 Dr. Nazli Rabienejad 31 • In abscesses presenting with severe swelling and inflammation, aggressive mechanical instrumentation should be delayed in favor of antibiotic therapy so as to avoid damage to healthy contiguous periodontal tissues • frequent rinsing with warm salt (1 tbsp/8-oz glass) and periodic application of chlorhexidine gluconate either by rinsing or locally with a cotton-tipped application Dr. Nazli Rabienejad 32 Dr. Nazli Rabienejad 33 Chronic Abscess • scaling and root planing or surgical therapy • Surgical treatment is suggested when deep vertical or furcation defects exist • antibiotic therapy may be indicated Dr. Nazli Rabienejad 34 Dr. Nazli Rabienejad 35 Acute Herpetic Gingivostomatitis • HSV 1, 2 • Isolated : gingivitis, periodontitis, necroziting • Primary infection with herpes simplex virus in the oral cavity • typically occurs in children, but it can occur in adults as well • 7 to 10 day course • usually heals without scarring • A recurrent herpetic episode may be precipitated in individuals with a history of herpesvirus infections by dental treatment, respiratory infections, sunlight exposure, fever, trauma, exposure to chemicals, and emotional stress. • EM Dr. Nazli Rabienejad 36 Acute Herpetic Gingivostomatitis Dr. Nazli Rabienejad 37 • Treatment consists of early diagnosis and immediate initiation of antiviral therapy. of an suspension given • Fever: 3 days to 1 day • new extraoral lesions: 5.5 to 0 days • difficulty with eating: 7 to 4 days • Viral shedding stopped at 1 day from 5 days • oral lesions: 10 to 4 days Dr. Nazli Rabienejad 38 • within 3 days of onset, acyclovir suspension should be prescribed: • 15 mg/kg 5 times daily for 7 days • If diagnosis occurs after 3 days in an immunocompetent patient, acyclovir therapy may have limited value • palliative care, including removal of plaque and food debris. • An NSAID (e.g., ibuprofen) to reduce fever and pain. • nutritional supplements or topical anesthetics (e.g., viscous lidocaine) before eating to aid in proper nutrition during the early phases • Local or systemic application of antibiotics is sometimes advised to prevent opportunistic infection of ulcerations Dr. Nazli Rabienejad 39 Recurrent type: some times intra oral recurrent: more than once a year, usually at the same previous place trauma, fever, UV dd (keratinized gingiva) Tx: plaque control, systemic antivirals, proflactic Dr. Nazli Rabienejad 40 • is contagious at certain stages such as when vesicles are present (highest viral titer). • Herpetic infection of a clinician’s finger, referred to as herpetic whitlow, can occur if a seronegative clinician becomes infected with a patient’s herpetic lesions Dr. Nazli Rabienejad 41 Dr. Nazli Rabienejad 42 با آرزوی موفقیت و سﻻمت [email protected].
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