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

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

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

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

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

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

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

12. Clinical features
 Features of chronic gingivitis
 Swollen, soft, discolored
 Bleeds on probing
 Gingival pocket ( >4mm)
 False pocket if gingiva is elongated towards crown.
 Recession of gum margin
 Mobile tooth
 Halitosis

14. Management
Maintain oral hygiene
Brushing
Mouth wash
Scaling to remove plaque and calculi
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

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

17. Pericoronitis
 Inflammation of the gingival tissue around an erupting tooth
 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
 Commonly occurs in the lower 3 rd molar at the age of 18 to
25 yrs
 But any tooth can be affected

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

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

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