Periodontitis: Difference between revisions
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==Background== | ==Background== | ||
* | *Chronic inflammatory condition of the supporting tissues of teeth caused by bacterial biofilm | ||
*Results in progressive destruction of periodontal ligament and alveolar bone | *Results in progressive destruction of periodontal ligament and alveolar bone | ||
*Major cause of tooth loss in adults | *Major cause of tooth loss in adults | ||
*'''EM relevance:''' Patients present with dental pain, gingival bleeding, or loose teeth; must differentiate from [[dental abscess]] and [[ANUG]] (acute emergencies) | |||
==Clinical Features== | ==Clinical Features== | ||
*Gingival bleeding | *Gingival bleeding, erythema, swelling | ||
*Deep periodontal pockets (>3mm) | *Deep periodontal pockets (>3mm) | ||
*Gingival recession | *Gingival recession, exposed root surfaces | ||
*Tooth mobility | *Tooth mobility | ||
*Halitosis | *Halitosis | ||
*Usually chronic and painless (pain suggests abscess complication) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Gingivitis]] | *[[Gingivitis]] — reversible gingival inflammation without bone loss | ||
*[[Dental abscess]] | *[[Dental abscess]] — localized fluctuant swelling, severe pain, possible systemic toxicity | ||
*[[ANUG]] | *[[ANUG]] (acute necrotizing ulcerative gingivitis) — acute onset, necrotic interdental papillae, fetid breath, pain, fever | ||
*[[Leukemia]] or other hematologic malignancy — gingival hyperplasia with bleeding | |||
==Evaluation== | ==Evaluation== | ||
*Clinical | *Clinical exam: assess for fluctuance, facial swelling, trismus, floor of mouth elevation ([[Ludwig's angina]]) | ||
*Dental radiographs showing bone loss | *'''In the ED:''' Rule out abscess and deep space infection | ||
*Dental radiographs showing alveolar bone loss (definitive, usually outpatient) | |||
==Management== | ==Management== | ||
*'''In the ED:''' Pain control, rule out abscess | |||
*Chlorhexidine 0.12% oral rinse BID | |||
*Antibiotics as adjunct for severe disease: | |||
*{{AntibioticDose|drug=Doxycycline|dose=100mg PO daily (as adjunct to scaling and root planing)|context=Periodontitis|disease=Periodontitis|population=Adult}} | *{{AntibioticDose|drug=Doxycycline|dose=100mg PO daily (as adjunct to scaling and root planing)|context=Periodontitis|disease=Periodontitis|population=Adult}} | ||
*Definitive treatment is scaling and root planing (dental office) | |||
==Disposition== | ==Disposition== | ||
* | *Outpatient dental/periodontal referral | ||
* | *'''Red flags requiring urgent evaluation:''' Facial swelling, trismus, dysphagia, floor of mouth elevation, fever | ||
==See Also== | ==See Also== | ||
*[[Dental abscess]] | *[[Dental abscess]] | ||
*[[ANUG]] | *[[ANUG]] | ||
*[[Gingivitis]] | |||
*[[Ludwig's angina]] | |||
==References== | ==References== | ||
Latest revision as of 01:48, 21 March 2026
Background
- Chronic inflammatory condition of the supporting tissues of teeth caused by bacterial biofilm
- Results in progressive destruction of periodontal ligament and alveolar bone
- Major cause of tooth loss in adults
- EM relevance: Patients present with dental pain, gingival bleeding, or loose teeth; must differentiate from dental abscess and ANUG (acute emergencies)
Clinical Features
- Gingival bleeding, erythema, swelling
- Deep periodontal pockets (>3mm)
- Gingival recession, exposed root surfaces
- Tooth mobility
- Halitosis
- Usually chronic and painless (pain suggests abscess complication)
Differential Diagnosis
- Gingivitis — reversible gingival inflammation without bone loss
- Dental abscess — localized fluctuant swelling, severe pain, possible systemic toxicity
- ANUG (acute necrotizing ulcerative gingivitis) — acute onset, necrotic interdental papillae, fetid breath, pain, fever
- Leukemia or other hematologic malignancy — gingival hyperplasia with bleeding
Evaluation
- Clinical exam: assess for fluctuance, facial swelling, trismus, floor of mouth elevation (Ludwig's angina)
- In the ED: Rule out abscess and deep space infection
- Dental radiographs showing alveolar bone loss (definitive, usually outpatient)
Management
- In the ED: Pain control, rule out abscess
- Chlorhexidine 0.12% oral rinse BID
- Antibiotics as adjunct for severe disease:
- Doxycycline 100mg PO daily (as adjunct to scaling and root planing)
- Definitive treatment is scaling and root planing (dental office)
Disposition
- Outpatient dental/periodontal referral
- Red flags requiring urgent evaluation: Facial swelling, trismus, dysphagia, floor of mouth elevation, fever