acute pericementitis

Acute Pericementitis: An Overview

Acute pericementitis is an inflammatory process that affects the tissues surrounding and supporting the teeth, including the gingiva (gums), alveolar bone, and periodontal membrane. This condition can lead to pain, swelling, and potentially serious complications if left untreated.

Characteristics of Acute Pericementitis

• Definition: An acute inflammatory process that affects the tissues surrounding and supporting the teeth.
• Symptoms: Pain, swelling, redness, and tenderness in the affected area.
• Causes: Bacterial infections, trauma to the tooth or surrounding tissues, and other factors can contribute to the development of acute pericementitis.

Types of Acute Pericementitis

There are several types of acute pericementitis, including:

• Acute marginal pericementitis: An inflammation restricted to the margin of the pericementum and often associated with marginal gingivitis.
• Acute diffuse suppurative pericementitis: A more severe form of the condition characterized by a widespread infection.
• Acute intraradicular pericementitis (also known as acute pericemental-paradental abscess): An inflammation within the pericementum arising from an infection that enters at the gingival margin.

Importance of Early Treatment

Early diagnosis and treatment are crucial in preventing further complications, such as bone loss and tooth loss. If left untreated, acute pericementitis can lead to more severe periodontal disease and potentially serious health issues.

References:

• [1] Definition: An acute inflammatory process that affects the tissues surrounding and supporting the teeth.
• [3] Description of acute pericementitis
• [11] Types of acute pericementitis, including acute marginal pericementitis, acute diffuse suppurative pericementitis, and acute intraradicular pericementitis (acute pericemental-paradental abscess)
• [12] Periodontitis is also known as pericementitis, or, most commonly, as gum disease. It is characterized by the inflammation of the periodontium.
• [13] Acute intraradicular pericementitis (acute pericemental–paradental abscess)—an acute, circumscribed, destructive inflammation (abscess) within the pericementum arising from an infection

Common Signs and Symptoms of Acute Pericarditis

Acute pericarditis, a condition characterized by inflammation of the pericardium (the fluid-filled sac surrounding the heart), presents with several distinct signs and symptoms. These can be divided into two categories: chest pain and other associated symptoms.

Chest Pain

• Sharp or stabbing pain: The most common symptom of acute pericarditis is a sharp, stabbing chest pain that often extends to the left shoulder and sometimes down the left arm [4][5].
• Location: This pain is usually felt on the left-hand side of the chest [10].

Other Associated Symptoms

• Cough: Some people may experience coughing as a symptom of acute pericarditis [1].
• Fatigue or general feeling of weakness: Feeling tired or weak can be another sign of this condition [1].
• Swelling of the legs or feet: Swollen legs and feet are also associated with acute pericarditis [1].
• Low-grade fever: A low-grade fever is a common symptom, indicating an underlying infection or inflammation [9].
• Pounding or racing heartbeat: Some individuals may experience palpitations as their heart rate increases due to the inflammation [1].

Diagnosis and Treatment

Prompt diagnosis and treatment are crucial for most people with acute pericarditis. This typically involves rest, medication, and sometimes hospitalization to manage symptoms and prevent complications.

References:

[1] Context result 1 [4] Context result 4 [5] Context result 5 [10] Context result 10

Diagnostic Tests for Acute Pericarditis

Acute pericarditis, an inflammation of the pericardium, can be diagnosed using various tests and evaluations. The following diagnostic tests are commonly used to diagnose and rule out acute pericarditis:

• Blood Tests: Blood tests may be done to check for signs of a heart attack, inflammation, and infection. These tests include:
  • Complete Blood Count (CBC) [5]
  • Erythrocyte Sedimentation Rate (ESR) [3]
  • C-Reactive Protein (CRP) [3]
  • Troponin [3]
• Electrocardiogram (ECG): An electrocardiogram is a quick and painless test that records the electrical signals in the heart. It can show signs of pericarditis, such as ST-elevation and PR-depression [6].
• Transthoracic Echocardiography: This imaging modality can demonstrate moderate or large effusions, cardiac tamponade, and constrictive pericarditis [3].
• Two-dimensional Doppler Echocardiography: This is the diagnostic test of choice for large effusions, cardiac tamponade, and constrictive pericarditis [3].
• Physical Examination: A physical examination can detect pericardial rubs at auscultation and additional possible signs of a systemic disease that may be responsible for pericarditis [2].

These diagnostic tests are used in combination with the patient's medical history and symptoms to diagnose acute pericarditis.

Treatment Options for Acute Pericarditis

Acute pericarditis, an inflammation of the pericardium, can be effectively treated with various medications. The primary goal of treatment is to reduce pain and inflammation, prevent complications, and promote healing.

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are often the first line of treatment for acute pericarditis. Examples include ibuprofen, indomethacin, and naproxen. NSAIDs help reduce pain and inflammation by blocking the production of prostaglandins.
  • [1] recommends NSAIDs as the initial treatment for acute idiopathic or viral pericarditis.
  • [7] suggests using NSAIDs such as ibuprofen at 600 mg three times a day (tds) for 1–2 weeks.
• Colchicine: This medication is often used in combination with NSAIDs to treat acute pericarditis, especially when the cause is viral or idiopathic. Colchicine helps reduce pain and inflammation by inhibiting microtubule formation.
  • [3] recommends colchicine as an adjunct to aspirin/NSAIDs for acute pericarditis.
  • [13] suggests using NSAIDs (in combination with colchicine) as the initial treatment for acute idiopathic or viral pericarditis.
• Glucocorticoids: These medications are typically reserved for severe cases of pericarditis. Glucocorticoids can help reduce inflammation and prevent complications, but their use should be carefully considered due to potential side effects.
  • [6] mentions glucocorticoids as a treatment option for severe or recurrent pericarditis.

Important Considerations

• Treatment duration: The length of time NSAIDs are prescribed varies depending on the individual case. Some sources suggest tapering treatment after 1–2 weeks, while others recommend longer durations.
  • [13] discusses two approaches to determine the duration of NSAID therapy and the proper time to begin tapering treatment.
• Potential complications: Acute pericarditis can lead to complications such as large pericardial effusion or tamponade. Treatment should aim to prevent these complications.

References

[1], [3], [6], [7], [13]

The differential diagnosis of acute pericarditis involves considering various conditions that can present with similar symptoms, such as chest pain and ST-segment elevation on electrocardiograms (ECGs). Some of the key differential diagnoses include:

• Myocardial infarction: This is a common condition to consider in the differential diagnosis of acute pericarditis, especially in patients who present with chest pain and ST-segment elevation on ECGs.
• Early repolarization abnormalities: These are commonly observed in healthy individuals and can be mistaken for acute pericarditis. They are characterized by an elevated J-point, often presenting as an initial slur at the beginning of the ST segment.
• Takotsubo syndrome: This is a condition that presents with chest pain, dyspnea, syncope, arrhythmias, and sudden cardiac death, usually in older female patients triggered by an emotional event or exertion.
• Pulmonary embolus, aortic dissection, pneumothorax, pneumonia, and acute myocardial infarction: These are other conditions that should be considered in the differential diagnosis of acute pericarditis.

According to [3], acute pericarditis is diagnosed in approximately 0.1% of patients hospitalized for chest pain and in 5% of patients admitted to the emergency department. The diagnosis requires the presence of at least two typical pericardial chest pain, pericardial friction rub, widespread ST-elevation and/or PR-depression on ECG.

The differential diagnoses of acute pericarditis are listed in [9] as follows:

• Angina pectoris
• Esophagitis
• Gastritis (acute)
• Gastroesophageal reflux disease
• Myocardial infarction
• Myocardial ischemia
• Peptic ulcer

It is essential to consider these differential diagnoses when evaluating patients with symptoms suggestive of acute pericarditis.

References:

[3] Acute pericarditis: diagnosis and management. Am J Med. 1982 May;65(5):1004-9. [9] Table 3. Differential Diagnosis of Acute Pericarditis.