• Sudden onset  Present diagnostic problems to the

clinician.
• Limited duration
Sheet 11: Acute Periodontal Conditions
• Well defined clinical criteria

Causes of gingival Subtypes Clinical Causes Manegment Extra notes

& periodontal acute presentation
lesions:
1. Traumatic a) Physical* -keratosis - chronic forceful 1. Remove the cause. -taking good history is
Lesions (chronic) brushing 2. Mild mouthwashes. very important
- Factitious nail 3. Topical remedies. (Oragel
biting habit ,Sulcoseryl and Orabase)
b) Thermal - flat erythematous - burn They only cover the ulcers and
area (desquamated promote healing.
tissue). 4. Secondary infection
antibacterial mouthwashes.
c) Chemical - Aspirin

2. Infectious a) Viral - Ulcers that present - Primary herpetic Subsides within 4-5 days -The recurrent herpes in
as vesicles gingivostomatitis. - if there’s fever/malaise a severe form happens
lesions usually after tiring
- red lesions on - The recurrent Provides the pt supportive
gingiva, mucosa, lips herpes in a severe treatments like(
and the palate. form
treatment: extractions, matrix band
1. Bed rest fluid, cool and soft retainer placements,
food. rubber dam clamps...
2. Acyclovir in severe cases. etc.).
3. Paracetamol.
b) Fungal Lesions - white -Differentiated from
/Erythematous 1. Nystatin. plaque by :
lesions 2. Amphptericin B. 1.their creamy
- Cribriform redness consistency
growing deep into the 2. After wipe it away
tissues. you see redness.

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 C) Bacterial -Bacterial infections are
chronic.
Lesions - Necrotizing ulcerative
✓ Necrotizing gingivitis is an ACUTE
lesions: NUG, form of bacterial
NUP, NUS. infection.
✓ Abscesses of the -site: marginal gingiva - impacted -remove the foreign body. -can occur in people
periodontium: or interdental papilla foreign body -not removed :rupture with periodontitis
1. Localized, painful, -iatrogenic spontaneously/ becomes
1. Gingival and rapidly expanding causes recurrent lesion
swelling with red,
abscess.
smooth shiny surface.
2. Fluctuant and
pointed.
-Sudden onset of: - Obstruction of 1. Incision & drainage the second most
2. Periodontal 1. Pain. 2. Red, bluish opening of through sulcus. common dental
abscess.(not swelling 3.lateral to deep pockets 2. Scaling & root planning. emergency after
apical) affected teeth. by: 3. Irrigation with saline or endodontic/periapical
4. Tooth is mobile, 1. Foreign body H2O2 (3%). abscesses
extruded “high” on impaction. 4. Periodontal surgery if -Vitality test is v.imp
occlusion. 2. Partial healing inaccessible. for DDX
5. Pus drain through of a deep pocket. 5. Antibiotics for 5 days - postoperative care is
pocket or sinus tracts 6. -other factors : followed by instrumentation. needed
Systemic involvement if root morphology/ (Only if the infection is -Complications:
infection disseminated. immune response spreading or if the patient is 1. Tooth loss.
immunocompromised). 2. Cellulitis
✓ Extraction if prognosis is -(there is detailed
poor. information about this
✓ We don’t take biopsy. subject in the sheet
refers to inflammation of Unless it didn’t respond to pages 7+8+11+12)
conventional tx
the gingiva in relation to
3. Pericoronal 1. Red, swollen -the space 1. Gently flushing the area -mostly in mand.3rd
the crown of an tenderness with warm water to remove molar.
abscess. between the
incompletely erupted 2. . Radiating pains to crown of the debris - Once the acute
(Pericoronitis)
tooth.

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 the ear, the throat, tooth and the 2. Swabbing with antiseptic. symptoms have
and floor of the overlying gingival 3. The occlusion is evaluated. subsided, the prognosis
mouth. flap (operculum) 4.Pericoronal flap: It may be of the tooth can be
3. Foul taste. is an ideal area necessary to reduce soft tissue evaluated.
4. Inability to close for the surgically and/or to
the jaws. accumulation of 5. Adjust the opposing tooth
5. Swelling of the food debris and ----------------------------------------
cheek in the region bacterial growth. 6. Antibiotics can be
of the angle of the prescribed in severe.
jaw. 7. If the gingival flap is swollen
6. Trismus. and fluctuant, an incision may
be necessary to
7. Systemic
8. Establish drainage and
involvement.
relieve pressure.
✓ Combined A) Primary a) start from a PA -always start with RCT pathways endodontic
periodontal- endodontic- origin (necrotic and periodontic lesions
endodontic secondary pulp)& spread communicate through:
lesions periodontic. to periodontal 1. Apex.
B) Primary periodontic- tissue 2. lateral canals +
secondary b) Start as pockets.
endodontic. periodontitis 3. accessory canals.
C) Combined pulp may be ( mainly found apically
periodontic- vital &in the furcation area)
endodontic lesion. c) periodontium 4. Rarely, through the
and pulp are exposed dentinal
diseased tubules.
independently
from each
other that are
combined at
some point.

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