perio 1 wk 4 ch 10 11 12 occlusal trauma abscesses

docx

School

Fortis Institute, Scranton *

*We aren’t endorsed by this school

Course

101

Subject

Medicine

Date

Dec 6, 2023

Type

docx

Pages

Uploaded by BrigadierKomodoDragonPerson731

Perio 1: Week 4 Chapter 10: Occlusal Trauma Centric Occlusion : defined as the maxillary intercuspation or contact of the max and mand teeth. Centric relation : is the most retruded (posterior) position of the jaw in relation to the maxilla in which lateral movements of the jaw can be made. Edward H. Angles classification system is used to determine class of malocclusion Malocclusion is a contributory risk factor for periodontal diseases Prematurity (aka occlusal interference): occurs when a tooth is hitting before all others when a patient bites, such as when a restoration is too high or a tooth's super-eruption (extrusion) places it above the line of occlusion. Physiologic occlusion : when a pt. is in malocclusion but is symptom-free and the dentition adapts to the deviation. Pathologic occlusion : occurs when pt. show signs or symptoms of the occlusal disease such as wear facets, attrition, abfraction, gingival trauma due to overbite/underbite, TMJ disorders etc Occlusal trauma (AKA occlusal disease); injury to the attachment apparatus (PDL, bone, cementum) as a result of normal or excessive occlusal forces. When the forces applied to teeth exceed the reparative abilities of the apparatus occlusal trauma results. Occlusal disease can also affect the TMJ, muscles of mastication, pulp tissue, and restorations. Parafunctional habits : nail biting, bruxism (grinding/clenching), tongue thrusting, thumb sucking, chewing inanimate objects. Bruxism causes wear facets/attrition, cusp fractures, sensitivity, and tooth mobility Tongue thrust or thumb sucking can cause a class II division I malocclusion where the anterior max teeth are flared outward with an open bite. Tongue thrust can also cause mouth breathing. Glickman 1963 introduced the idea of codestruction , saying occlusal trauma in the presence of inflammation will accelerated the rate of inflammation/periodontal destruction. stating it alters the pathway of inflammation and causes it to spread more rapidly straight from the gingiva to the PDL causing vertical bone defects and infrabony pockets. So the progression of periodontitis is accelerated by occlusal trauma. What causes the vertical bone loss and mobility? Heavy occlusal loads causing compression of PDL fibers reduce blood flow, causing an increased rate of bone resorption. Excessive chronic occlusal forces cause the PDL to widen because it can't keep up with the repairs- this causes more bone resorption/vertical bone defects, PDL gets even wider to accommodate bone loss and results in increasing tooth mobility.

Primary occlusal trauma : damage to the attachment apparatus due to occlusal forces in a HEALTHY periodontium. Causes- premature contacts (high fillings), parafunctional habits, malpositioned tooth/teeth, periapical abscess causing extrusion of a tooth, orthodontic movement of teeth, a physical blow, a removable partial denture clasp around an abutment tooth. Secondary occlusal trauma : results when normal or excessive occlusal forces cause injury in a periodontium with reduced bone support. The MOST common sign of occlusal trauma is increased tooth mobility For the proper determination of occlusal disease - tooth mobility must be assessed on 2 separate occasions to see if its adapting or steadily worsening CLINICAL FINDINGS: Adapted mobility - for example a tooth with high restoration causing premature contact will become mobile to adapt to the occlusal forces and plateau (not become any worse) Tooth hypermobility DOES NOT cause gingival inflammation or increase CAL Fremitus: the vibrational movement of a tooth under occlusal function. Check by placing finger on tooth while pt. bites. Pain: pain upon percussion, biting, and hypersensitivity are symptoms of occlusal trauma pathologic migration : a change in tooth position resulting from disruption of the forces that maintain it in normal position- is usually indicative of severe perio and secondary occlusal trauma. Results in diastema, flaring or fanning of anterior or extrusion/supereruption Attrition/wear facets : wearing of occlusal/incisal surface, may be ground flat, dentin showing, cracks/pits form on edges. Temporalis and masseter may become chronically sore and cause headaches. Pain usually occurs upon waking in the AM if a nighttime bruxer or chewing, pain usually emanates from the TMJ. RADIOGRAPHIC FINDINGS: Crestel funneling : widening of the PDL seen at the coronal third of root. PDL space is the white surrounding the lamina dura around the root Vertical bone loss accompanied by widened PDL Hypercementosis: excessive cementum deposited on the apical part of root With dental implants , there is no PDL to adapt to occlusal force overloads. This is the main cause of implant complications. The bond between the bone and implant abutment may be disrupted resulting in bone loss and failure. Treating occlusal trauma : selective grinding, control of parafunctional habits, orthodontic teeth movement, splinting, restorative procedures.

The objective of occlusal therapy : is to control the direction, duration, magnitude and frequency of excessive occlusal forces. Occlusal treatment has been shown to reduce the progression of perio disease greatly Splinting: treatment of choice for pt. who has discomfort or mobility that interferes with chewing. Used to connect multiple teeth with bone loss together for more support. Permits healing of the attachment apparatus. PDL becomes narrower and mobility reduces. Chapter 11: Abscesses Gingival abscess : acute infection limited to the GM- characterized by localized painful edema at the GM or papilla. Etiology - foreign object in the sulcus such as popcorn kernel, seeds, toothbrush bristle, fish bones. Onset : sudden, rapid development in 24-48 hrs. Treatment : debridement of affected area and salt water rinses every 2 hrs. for a week. Considerations: don’t inject local into infected site, may spread it. Scaling establishes drainage thru crevice. Should resolve in 24-48 hrs. Periodontal abscess AKA lateral abscess: the MOST common type. It’s a localized purulent nidus of acute inflammation as a result of bacterial invasion into the gingival soft tissue wall of a pocket. May cause destruction to the PDL and bone. Inflammation results in collagen destruction. Contains: bacteria, their by-products, inflammatory cells, tissue breakdown products, and serum. Usually occurs in teeth w/deep pockets or furcation. These are part of the clinical course of the progression of periodontitis Factors associated with periodontal abscess formation: 1. preexisting untreated periodontitis 2. an endodontic infection where there are lateral canals 3. furcation involvement 4. inadequate debridement was performed, so calc is still at the base of the pocket, but the coronal part is clear and heals, occluding the sulcus and not allowing drainage 5. patients with diabetes are more susceptible Microbes found in a perio abscess resemble the microflora of those in chronic periodontitis Cultivated from the exudate of the abscess is mostly gram-negative anaerobic rods The bacteria highly associated w/ this abscess formation is P. gingivalis The acute abscess presents as a shiny, swollen, discolored mass on the gingiva or lateral aspect NEVER at the GM. And the chief complaint of pt. developing one is pressure in the gums. Clinically the tooth may: be tender to percussion, mobile, deep probe depths, and edematous gingiva. Shows radiographically as radiolucent area on lateral

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

Treatment : incision/drainage thru pocket, debridement, may include periodontal surgery or tooth extraction. Antibiotics if lymphadenopathy or fever present. Periapical abscess: at the apex of a necrotic nonvital tooth, often heals following edno treatment. May have a sinus track draining it. The track can be traced by taking an x-ray w/ a gutta percha point within the sinus tract. Signs: tooth tender to percussion, tooth may be extruded from abscess at apex pushing it upward, No pocket present usually. Tooth mobility possible Origin: pulp chamber Location: sinus tract below apex Treatment: RCT- no antibiotic if the tooth is nonvital. But yes, if fever/lymph involvement Pericoronal abscess: AKA pericoronitis. Localized infection involving the gingiva adjacent to a partially erupted tooth, usually seen on mand. 3 rd molars. The OPERCULUM or gingival flap overlying the erupting tooth is red and edematous w/ debris collected underneath. It will disappear once the tooth fully erupts or is extracted. Gram-negative anaerobes involved Signs : trismus (lock jaw/limited opening) possible if infection spreads, difficulty swallowing, dull aching pain, facial swelling, possible lymphadenopathy. Origin: gingiva location: partially erupted molar Xray findings : impacted molar Treatment: Irrigation w/ saline or iodine under flap to flush debris, antibiotics if fever/lymph. And extraction of tooth if impacted Primary Herpetic Gingivostomatitis : condition of the oral mucosa characterized by a previous herpes (HSV-1) infection. Signs: after a brief prodromal period of fever, headache, nausea, vomiting, and malaise, many small blisters/vesicles form on the mucosa inside lower lip, hard palate and/or tongue. These break forming yellowish-gray ulcers in groups surrounded by red halos (inflammation). Symptoms last 1-2 wks. Transmission; many acquire it thru direct contact like kissing a person w/ active recurrent lesions Its important to differentiate between this and NUG: one of the most important distinguishing factors which is diagnostic for PHG is the presence of generalized acute gingivitis. The papilla are intact and not necrotic. The gingiva is red and swollen. Submandibular lymphadenopathy is present. Another differential diagnosis: aphthous stomatitis (canker sores) occur ONLY on the attached gingiva and pt. has history of recurrence Treatment: palliative. Rinse with xylocaine for pain, antipyretics like acetaminophen to reduce fever/pain, antiviral drug Acyclovir.

Chapter 12: The DH process of care for pt. with perio disease A ssessment D iagnosis P lanning I mplementation E valuation D ocumentation Subjective: statements made by the patient Objective: direct measurements/recorded data of pt. and statements made by clinicians The purpose of the DH process of care is to provide a framework within which the individual needs of the pt. can be met. DH diagnosis : the identification of an existing or potential oral health problem that the DH is educationally qualified and licensed to treat. Dental diagnosis VS. DH diagnosis : A dental diagnosis gives a name to the disease, whereas the DH diagnosis identifies the patient's actual or potential response to the disease process. The purpose of the DH diagnosis is to keep treatment planning centered on problems that are responsive to DH interventions. Planning is the establishment of realistic goals and treatment strategies to facilitate optimal oral health The DH care plan : involves the development of written interventions for the pt. individual needs based on data collected during the assessment. Must include recommended treatments, their alternatives, side effects, sequences, and expected outcome. Must be signed by the patient (informed consent). Interventions: procedures carried out by DH to help pt. reach desired health goals Describe aspects of a treatment plan: After all data from the assessment phase has been analyzed and a DH diagnosis reached, a treatment plan is devised tailored to that patient's individual needs. It is based on the data collected and the patient's current or potential response to the disease process. It lays out the suggested sequence of treatments, the cost, alternative options, possible side effects, and the predicted outcome. All of this must be included and presented to the patient to obtain informed consent before proceeding to the implementation phase. The treatment plan can consist of routine prophylaxis, quad scaling/root planing, coronal polishing, application of fluoride or desensitizing agents, local anesthetic administrations, whitening procedures as well as patient education and nutritional or tobacco cessation counseling. It keeps the entire dental care plan in mind when sequencing said treatments alongside work being performed by the dentist or other practitioners.

perio 1 wk 4 ch 10 11 12 occlusal trauma abscesses

Related Documents