Many periodontitis patients are not aware of their disease, even though it may have been progressing over many years. Only when pain and acute inflammatory symptoms appear do such patients seek out a dentist or dental hygienist.
Such emergency cases must be treated immediately. However, to avoid life-threatening incidents, a succinct general medical history must be taken, with particular attention to any medicines the patient may be taking (anticoagulants!) and an assessment of the necessity for infection prophylaxis (endocarditis, HIV etc.), as well as allergies and previous significant incidents.
Next, a clinical and radiographic examination should be performed for emergency patients; despite the pain, this is absolutely necessary before any treatment.
Included in the category “periodontal emergency situations and treatments” are:
Initial topical medicinal and mechanical treatment for acute NUG
Treatment of acute, suppurating pockets
Opening periodontal abscesses
Immediate extraction of hopelessly mobile teeth that cannot be maintained
Acute, combined endodontic-periodontal problems
Treatment of periodontal trauma following accidents
Acute ulcerative gingivoperiodontitis (acute NUG/NUP) is painful and progresses very rapidly. Careful instrumentation and application of topical agents generally bring relief within a few hours and a reduction of the acute situation.
Caution: Ulceration may be a symptom of HIV-seropositivity (opportunistic infection).
Active suppurating pockets generally are not painful if drainage is established at the gingival margin (exception: abscess). Such pockets represent an exacerbating inflammatory process, which leads to rapid attachment loss. They must be treated immediately with application of rinsing solutions or ointments; mechanical cleansing must also be initiated.
Periodontal abscesses are usually very painful. They must be drained immediately. This can usually be accomplished via probing from the gingival sulcus.
In the case of molars with deep pockets or furcation involvement, an abscess that penetrates the bone may develop subperiosteally. These cannot always be reached via the gingival margin, and must be drained by means of an incision.
Immediate extraction should be reserved for teeth that cannot be maintained or are highly mobile or which cause the patient undue discomfort. In the case of anterior teeth, for esthetic reasons, extractions should be avoided when possible, or an immediate temporary should be prepared.
Acute, endodontic/periodontal processes have a more favorable prognosis if the primary problem is of endodontic origin. The root canal should always be treated first, subsequently the pocket.
Periodontal trauma due to accident usually requires immediate splinting (following any necessary reimplantation or repositioning of the tooth).