1. Periodontitis Periodontitis Acute periodontitis Acute inflammation of the perodontal ligament gradually involving the whole periodontium Acute inflammation of the perodontal ligament gradually involving the whole periodontium Causes (4I) Injury: trauma due to external force or bite on hard object Injury: trauma due to external force or bite on hard object Infection: Pulpitis, ANUG Infection: Pulpitis, ANUG Irritation due to improper filling Irritation due to improper filling Impaction of foreign body (meat bone) Impaction of foreign body (meat bone) Etiological agent – Streptococcus, Staphylococcus, Borrelia vincenti Etiological agent – Streptococcus, Staphylococcus, Borrelia vincenti Fusiform bacillus Fusiform bacillus Dr S Chakradhar 1

4. Clinical features Toothache Toothache Patient feels that the tooth is extruded Patient feels that the tooth is extruded Fever Fever Malaise Malaise Enlarged cervical LN Enlarged cervical LN Dr S Chakradhar 4

5. Management Treat/remove the cause Treat/remove the cause Soft diet Soft diet Advise not to chew from affected side Advise not to chew from affected side Gargle with warm saline Gargle with warm saline Analgesics and anti inflammatory Analgesics and anti inflammatory Antibiotics Antibiotics Prevent further damage by proper oral hygiene Prevent further damage by proper oral hygiene Dr S Chakradhar 5

6. Periapical abscess Usually a progression of periodontitis Usually a progression of periodontitis History History Severe throbbing pain Severe throbbing pain Tenderness Tenderness Diffuse swelling Diffuse swelling Fever Fever

8. On examination Inability to occlude Inability to occlude Fluctuant swelling in buccal or lingual region Fluctuant swelling in buccal or lingual region Sensitive to percussion Sensitive to percussion Mobility Mobility X ray may show periapical radiolucency X ray may show periapical radiolucency

9. Management Incision and drainage Incision and drainage Don’t give local infiltration as chances of dissemination of infection is there Don’t give local infiltration as chances of dissemination of infection is there Antibiotic coverage Antibiotic coverage Analgesic Analgesic Maintenance of oral hygiene Maintenance of oral hygiene

10. Chronic periodontitis Causes Causes Chronic gingivitis Chronic gingivitis Occlusal trauma Occlusal trauma Improper application of orthodontic appliance (excess force) Improper application of orthodontic appliance (excess force)Pathology Destruction of periodontal ligament Destruction of periodontal ligament Formation of periodontal pocket Formation of periodontal pocket Resorption of alveolar bone Resorption of alveolar bone Loosening of teeth Loosening of teeth

12. Clinical features Features of chronic gingivitis Features of chronic gingivitis Swollen, soft, discolored Swollen, soft, discolored Bleeds on probing Bleeds 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 margin  Mobile tooth  Halitosis

14. Management Maintain oral hygiene Maintain oral hygiene Brushing Brushing Mouth wash Mouth wash Scaling to remove plaque and calculi Scaling to remove plaque and calculi Subgingival curettage of pocket, to allow normal reattachment of gingival and periodontal tissue Subgingival curettage of pocket, to allow normal reattachment of gingival and periodontal tissue Mucogingival flap operation: curettage of granulation tissue, dead bone and cementum beneath a flap of gingiva Mucogingival flap operation: curettage of granulation tissue, dead bone and cementum beneath a flap of gingiva

16. Complications Intraoral and extraoral abscess Intraoral and extraoral abscess Maxillary sinusitis Maxillary sinusitis Ostemyelitis of jaw Ostemyelitis of jaw Cellulitis of face Cellulitis of face Dissemination of infection: bacteremia, septicemia Dissemination of infection: bacteremia, septicemia

17. Pericoronitis Inflammation of the gingival tissue around an erupting tooth Inflammation of the gingival tissue around an erupting tooth When the eruption is partial, there is an opening through the mucus membrane and When the eruption is partial, there is an opening through the mucus membrane and rest of the crown is covered by a flap of gum which is known as operculum rest of the crown is covered by a flap of gum which is known as operculum Commonly occurs in the lower 3 rd molar at the age of 18 to 25 yrs Commonly occurs in the lower 3 rd molar at the age of 18 to 25 yrs But any tooth can be affected But any tooth can be affected

19. Causes Food stagnation and impaction Food stagnation and impaction Upper tooth traumatizing lower gum flap Upper tooth traumatizing lower gum flap Vincent’s infection – acute gingivitis caused by borella vincemtis & fuscobacterium Vincent’s infection – acute gingivitis caused by borella vincemtis & fuscobacterium Eruption irritation Eruption irritation Immunocompromised host Immunocompromised host

20. Clinical features Pain Pain Swollen operculum Swollen operculum Trismus Trismus Halitosis Halitosis Fever and enlarged cervical LN Fever and enlarged cervical LN Purulent exudate Purulent exudate Abscess formation Abscess formation

22. Management Clean with 3%H2O2 Clean with 3%H2O2 Nascent O2 is bactericidal Nascent O2 is bactericidal Normal saline wash Normal saline wash Maintain oral hygiene Maintain oral hygiene Brushing Brushing Antiseptic mouthwash Antiseptic mouthwash Chlorhexidine, Betadine, Chlorhexidine, Betadine, Soft diet Soft diet Analgesic and anti inflammatory Analgesic and anti inflammatory Amoxycillin 500mg tds for 5 to 7 days Amoxycillin 500mg tds for 5 to 7 days Or Erythromycin 250mg qid for 5 to 7 days Operculectomy Operculectomy Removal of upper tooth may be necessary Removal of upper tooth may be necessary