PeriodontitisPeriodontitisAcute periodontitisAcute periodontitis Acute inflammation of the perodontal ligament gradually Acute inflammation of the perodontal ligament gradually

involving the whole periodontiuminvolving the whole periodontium

Causes (4I)Causes (4I) Injury: trauma due to external force or bite on hard objectInjury: trauma due to external force or bite on hard object Infection: Pulpitis, ANUGInfection: Pulpitis, ANUG Irritation due to improper fillingIrritation due to improper filling Impaction of foreign body (meat bone)Impaction of foreign body (meat bone)

Etiological agent – Streptococcus, Staphylococcus, Borrelia vincentiEtiological agent – Streptococcus, Staphylococcus, Borrelia vincenti Fusiform bacillusFusiform bacillus

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Clinical featuresClinical featuresToothacheToothachePatient feels that the tooth is Patient feels that the tooth is

extrudedextrudedFeverFeverMalaiseMalaiseEnlarged cervical LNEnlarged cervical LN

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ManagementManagementTreat/remove the causeTreat/remove the causeSoft dietSoft dietAdvise not to chew from affected sideAdvise not to chew from affected sideGargle with warm salineGargle with warm salineAnalgesics and anti inflammatoryAnalgesics and anti inflammatoryAntibiotics Antibiotics Prevent further damage by proper oral hygienePrevent further damage by proper oral hygiene

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Periapical abscessPeriapical abscess Usually a progression of periodontitisUsually a progression of periodontitis HistoryHistory

Severe throbbing painSevere throbbing pain TendernessTenderness Diffuse swellingDiffuse swelling FeverFever

On examinationOn examination Inability to occludeInability to occlude Fluctuant swelling in buccal or lingual regionFluctuant swelling in buccal or lingual region Sensitive to percussionSensitive to percussion MobilityMobility X ray may show periapical radiolucencyX ray may show periapical radiolucency

ManagementManagement Incision and drainageIncision and drainageDon’t give local infiltration as chances Don’t give local infiltration as chances

of dissemination of infection is thereof dissemination of infection is thereAntibiotic coverageAntibiotic coverageAnalgesicAnalgesicMaintenance of oral hygieneMaintenance of oral hygiene

Chronic periodontitisChronic periodontitis CausesCauses

Chronic gingivitisChronic gingivitis Occlusal traumaOcclusal trauma Improper application of orthodontic appliance (excess Improper application of orthodontic appliance (excess

force)force)

PathologyPathology Destruction of periodontal ligamentDestruction of periodontal ligament Formation of periodontal pocketFormation of periodontal pocket Resorption of alveolar boneResorption of alveolar bone Loosening of teethLoosening of teeth

Clinical featuresClinical features Features of chronic gingivitisFeatures of chronic gingivitis Swollen, soft, discoloredSwollen, soft, discolored Bleeds on probingBleeds on probing Gingival pocket ( >4mm)Gingival pocket ( >4mm) False pocket if gingiva is elongated towards crown.False pocket if gingiva is elongated towards crown. Recession of gum marginRecession of gum margin Mobile toothMobile tooth HalitosisHalitosis

ManagementManagementMaintain oral hygieneMaintain oral hygiene

BrushingBrushingMouth washMouth wash

Scaling to remove plaque and calculiScaling to remove plaque and calculiSubgingival curettage of pocket, to Subgingival curettage of pocket, to allow normal reattachment of gingival allow normal reattachment of gingival and periodontal tissueand periodontal tissueMucogingival flap operation: curettage Mucogingival flap operation: curettage of granulation tissue, dead bone and of granulation tissue, dead bone and cementum beneath a flap of gingivacementum beneath a flap of gingiva

ComplicationsComplications Intraoral and extraoral abscessIntraoral and extraoral abscessMaxillary sinusitisMaxillary sinusitisOstemyelitis of jawOstemyelitis of jawCellulitis of faceCellulitis of faceDissemination of infection: Dissemination of infection:

bacteremia, septicemiabacteremia, septicemia

PericoronitisPericoronitis Inflammation of the gingival tissue around an erupting Inflammation of the gingival tissue around an erupting

toothtooth When the eruption is partial, there is an opening When the eruption is partial, there is an opening

through the mucus membrane and through the mucus membrane and rest of the crown is covered by a flap of gum which is rest of the crown is covered by a flap of gum which is

known as operculumknown as operculum Commonly occurs in the lower 3Commonly occurs in the lower 3rdrd molar at the age of molar at the age of

18 to 25 yrs18 to 25 yrs But any tooth can be affectedBut any tooth can be affected

CausesCausesFood stagnation and impactionFood stagnation and impactionUpper tooth traumatizing lower gum Upper tooth traumatizing lower gum

flapflapVincent’s infection – acute gingivitis Vincent’s infection – acute gingivitis

caused by borella vincemtis & caused by borella vincemtis & fuscobacteriumfuscobacterium

Eruption irritationEruption irritationImmunocompromised hostImmunocompromised host

Clinical featuresClinical features PainPain Swollen operculumSwollen operculum TrismusTrismus HalitosisHalitosis Fever and enlarged cervical LNFever and enlarged cervical LN Purulent exudatePurulent exudate Abscess formationAbscess formation

ManagementManagement Clean with 3%H2O2 Clean with 3%H2O2

Nascent O2 is bactericidalNascent O2 is bactericidal Normal saline washNormal saline wash Maintain oral hygieneMaintain oral hygiene

BrushingBrushing Antiseptic mouthwashAntiseptic mouthwash

Chlorhexidine, Betadine, Chlorhexidine, Betadine, Soft dietSoft diet Analgesic and anti inflammatoryAnalgesic and anti inflammatory Amoxycillin 500mg tds for 5 to 7 daysAmoxycillin 500mg tds for 5 to 7 days

Or Erythromycin 250mg qid for 5 to 7 daysOr Erythromycin 250mg qid for 5 to 7 days OperculectomyOperculectomy Removal of upper tooth may be necessaryRemoval of upper tooth may be necessary