15. Non plaque induced inflammatory gingival diseases Flashcards
Non plaque induced factors
- Bacterial
- Viral
- Fungal
- Gingival manifestation of immunosuppresion
- Gingival lesion of genetic origin
- Mucocutaneous disorders
- Allergic lesions
- Traumatic lesions
Non plaque induced inflammatory gingival diseases
Bacterial
- Neisseria gonorrhoea
- Treponema pallidium
- Mycobacterium tuberculosae
Non plaque induced inflammatory gingival diseases
Neisseria gonorrhoea clinical features
- Grey and white patches
- Covered w/ pseudomembranes
- Pain and paresthesia
- Fever
Patches over soft palate, tongue, buccal mucosa and tonsils
Non plaque induced inflammatory gingival diseases
Treponema pallidium
- Young patients
- Small papillae
- Ulcus durum-non painful
- Enlarged non painful lymph nodes
Surface of lips, tongue, palate, gingiva tonsils
Non plaque induced inflammatory gingival diseases
Mycobacterium tuberculosae
- Ulcers
- Very painful and infectious
- lymphadenopathy
Non plaque induced inflammatory gingival diseases
Viral
- Herpes simplex 1 and 2
- Varicella zoster virus
Non plaque induced inflammatory gingival diseases
Causes chicken pox
Varicella zoster virus
mainly in children
Non plaque induced inflammatory gingival diseases
Herpes clinical manifestation
- Both manifestations can involve gingiva
- Small ulcers on tongue, palate and gingiva
- Chicken pox-fever, malaise and skin rash
Non plaque induced inflammatory gingival diseases
Herpes zoster additional symptoms
- Pain and paresthesia
- Unilateral lesions
- 1-2 weeks to heal
Non plaque induced inflammatory gingival diseases
Treatment of herpes
- Soft liquid diet and rest
- Plaque removal and diluted chlorhexidine rinses
- Acyclovir
- Famcyclovir
- Valacyclovir
Non plaque induced inflammatory gingival diseases
Fungal
- Candidosis
- Histoplasmosis
- Aspergillosis
- Blastomycosis
Non plaque induced inflammatory gingival diseases
Candidosis
- -C. Albicans
- Opportunistic
- Rarely affects gingiva
- Gingival lesions- redness at attached gingiva, granular surface
Non plaque induced inflammatory gingival diseases
Predisposing factors for candidosis
- Local=>Reduced salivary flow
- Systemic=>
- Antibiotics
- Corticosterioids
- Smoking, diabetes, HIV
Non plaque induced inflammatory gingival diseases
Types of candidosis
- Pseudomembranous
- Erythematous
- Plaque type
- Nodular
- Histoplasmosis(Granulomatous disease)
Non plaque induced inflammatory gingival diseases
Pseudomembranous Candidosis
- Non painful whitish patches
- Can be wiped off leaving bleeding surface
- No major symptoms
Palatal, buccal and labial mucosa
Non plaque induced inflammatory gingival diseases
Erythematous Candidosis
- Intensely red lesions
- Severe pain
- Anywhere on oral mucosa
Palate and lingual mucosa
Non plaque induced inflammatory gingival diseases
Plaque type Candidosis
- Whitish plaque
- Cannot be removed
- No symtpoms
- Indistinguishable from oral leukoplakia
Non plaque induced inflammatory gingival diseases
Nodular Candidosis
- Rare gingival presentation
- Slightly elevated nodules of white or reddish colour
Non plaque induced inflammatory gingival diseases
Diagnosis of candidosis
- Culture, smear, biopsy
- Topical-Clotrimazole, Nystatin
- Systemic-Ketoconazole, Fluconazole, Amphotericin B
Non plaque induced inflammatory gingival diseases
- Histoplasmosis (Granulomatous disease)
- Nodular=>papillary lesion
- Can become ulcerative and painful w/ loss of gingival tissue
- Can resemble malignant tumour
Non plaque induced inflammatory gingival diseases
Gingival manifestation of immunosuppression
Linear gingival erythema
Non plaque induced inflammatory gingival diseases
Linear gingival erythema
- 2-3 mm marginal band or erythema in Free gingiva
- Can extend to attached gingiva and beyond MGJ
- Commonly generalised
If localised-1 or 2 teeth
Rinse with chx gluconate x2 daily
Non plaque induced inflammatory gingival diseases
Gingival lesions of genetic origin
- Hereditary gingival fibromatosis
- Lichen planus
Non plaque induced inflammatory gingival diseases
Hereditary gingival fibromatosis
- Diffuse gingival enlargement
- Firm dense fibrous tissue
- Pseudopockets
Surgical removal indicated-gingivectomies
Non plaque induced inflammatory gingival diseases
Lichen planus
- Papules and white striae
- Lesions disappear spontaneously
- Skin and mucous membranes affected
-Striae-> Wickham striae
-Autoimmune component
Non plaque induced inflammatory gingival diseases
Mucocutaneous disorders
- Bullous pemphigoid
- Mucomembranous pemphigoid
- Pemphigus vulgaris
- Erythema multiforme
Non plaque induced inflammatory gingival diseases
Pemphigoid
- Chronic autoimmune disease
- Antibodies to components of lamina Lucida of basement membrane=>Detachement of epitheium from CT
Non plaque induced inflammatory gingival diseases
Bullous pemphigoid
- Oral=>desquamative gingivitis and bullous lesions
- Bullae=>rupture and leave ulcerative lesions
- Skin-Nikolsky sign
Treatment w/ topical steroids and tetracyclines
Non plaque induced inflammatory gingival diseases
Mucous membrane pemphigoid
- Desquamative lesions=>Intensively erythematous gingiva
- Ulcerative lesions after rupture of bullae w/ bleeding surface
- Fibrin coated ulcers yellowish/red
-Involes mucosa of nose, vagina, rectum, oesophagus
-Local treatment-Plaque removal, Chx mouthwash, topical corticosteroids
-Systemic treatment-Corticosteroids(prednisone, dapsone), immunosuppressive agents-methotraxate
Non plaque induced inflammatory gingival diseases
Pemphigus vulgaris
- Widespread bulla formation
- Early lesions resemble apthous ulcers
- Widespread erosions
- Gingival involvement=>desquamative lesions, erosions or ulcers
Treatment-corticosteroids, plaque removal
Non plaque induced inflammatory gingival diseases
Erythema multiforme
- Widespread mucosal lesions
- Bullae that rupture leaving ulcers
- Covered by yellowish fibrinous exudates
- Pseudomembranes-swollen lips
Oral, occular and genital lesions
