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of the surrounding connective tissues and, in contrast to a chronic inflammatory lesion, has a greater potential for resolution if quickly managed.
extends beyond the gingiva and bone denudation may occur through the alveolar mucosa, with larger areas of osteitis and formation of bone sequestrum. It typically occurs in severely systemically com - promised patients. Atypical cases have also been reported, in which necrotizing stomatitis may develop without prior appearance of nec - rotizing gingivitis/periodontitis lesions.
What is the case definition of a periodontal abscess? Periodontal abscess is a localized accumulation of pus located within the gingival wall of the periodontal pocket/sulcus, resulting in a sig - nificant tissue breakdown. The primary detectable signs/symptoms as - sociated with a periodontal abscess may involve ovoid elevation in the gingiva along the lateral part of the root and bleeding on probing. Other signs/symptoms that may also be observed include pain, suppuration on probing, deep periodontal pocket, and increased tooth mobility. A periodontal abscess may develop in a pre‐existing periodon - tal pocket, e.g., in patients with untreated periodontitis, under supportive therapy or after scaling and root planing or systemic an - timicrobial therapy. A periodontal abscess occurring at a previously periodontally healthy site is commonly associated with a history of impaction or harmful habits. Do necrotizing periodontal diseases have a distinct pathophysiology when compared to other periodontitis lesions? Yes. Necrotizing gingivitis lesions are characterized by the presence of ulcers within the stratified squamous epithelium and the superfi - cial layer of the gingival connective tissue, surrounded by a non‐spe - cific acute inflammatory infiltrate. Four zones have been described: (1) superficial bacterial zone, (2) neutrophil‐rich zone, (3) necrotic zone and (4) a spirochetal/bacterial infiltration zone. Necrotizing periodontal diseases are strongly associated with impairment of the host immune system, as follows: (1) in chronically, severely compromised patients (e.g., AIDS patients, children suffer - ing from severe malnourishment, extreme living conditions, or se - vere infections) and may constitute a severe or even life‐threating condition; and (2) in temporarily and/or moderately compromised patients (e.g., in smokers or psycho‐socially stressed adult patients).
Do endo‐periodontal lesions have a distinct pathophysiology when compared to other periodontitis or endodontic lesions?
The term endo‐periodontal lesion describes a pathologic communica - tion between the pulpal and periodontal tissues at a given tooth that may be triggered by a carious or traumatic lesion that affects the pulp and, secondarily, affects the periodontium; by periodontal destruction that secondarily affects the root canal; or by concomitant presence of both pathologies. The review did not identify evidence for a distinct pathophysiology between an endo‐periodontal and a periodontal le - sion. Nonetheless, the communication between the pulp/root canal system and the periodontium complicates the management of the in - volved tooth. What is the case definition of an endo‐periodontal lesion? Endo‐periodontal lesion is a pathologic communication between the pulpal and periodontal tissues at a given tooth that may occur in an acute or a chronic form. The primary signs associated with this lesion are deep periodontal pockets extending to the root apex and/or nega - tive/altered response to pulp vitality tests. Other signs/symptoms may include radiographic evidence of bone loss in the apical or furcation re - gion, spontaneous pain or pain on palpation/percussion, purulent exu - date/suppuration, tooth mobility, sinus tract/fistula, and crown and/or gingival color alterations. Signs observed in endo‐periodontal lesions associated with traumatic and/or iatrogenic factors may include root perforation, fracture/cracking, or external root resorption. These con - ditions drastically impair the prognosis of the involved tooth. Which are the current key gaps in knowledge that would inform a better classification of periodontitis and should be addressed in future research? Future research should: 1. Develop improved methodologies to assess more accurately the longitudinal soft and hard tissue changes associated with periodontitis progression 2. Identify genetic, microbial, and host response‐associated markers that differentiate between distinct periodontitis phenotypes, or which can reflect the initiation and progression of periodontitis. 3. Expand existing epidemiological databases to include world re - gions currently underrepresented, utilizing consistent, standard - ized methodologies, and capturing and reporting detailed data on
What are the case definitions of necrotizing periodontal diseases?
Necrotizing gingivitis is an acute inflammatory process of the gingival tissues characterized by presence of necrosis/ulcer of the interden - tal papillae, gingival bleeding, and pain. Other signs/symptoms asso - ciated with this condition may include halitosis, pseudomembranes, regional lymphadenopathy, fever, and sialorrhea (in children). Necrotizing periodontitis is an inflammatory process of the peri - odontium characterized by presence of necrosis/ulcer of the inter - dental papillae, gingival bleeding, halitosis, pain, and rapid bone loss. Other signs/symptoms associated with this condition may include pseudomembrane formation, lymphadenopathy, and fever. Necrotizing stomatitis is a severe inflammatory condition of the periodontium and the oral cavity in which soft tissue necrosis
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