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Perio > 21. Necrotising periodontal disease > Flashcards

21. Necrotising periodontal disease Flashcards

1
Q

Types of Necrotising periodontal diseases

A
  • Necrotising gingivitis
  • Necrotising periodontitis
  • Necrotising stomatitis

-Acute
-Recurrent
-Chronic

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2
Q

Necrotising gingivitis

A
  • Destructive inflammatory gingival condition
  • Limited to gingival tissue w/ no loss of attachment
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3
Q

Necrotising Periodontitis

A
  • Loss of attachment(gingiva, PDL, Alveolar bone)
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4
Q

Necrotising stomatitis

A

Progession of the disease beyond the MGJ

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5
Q

Prevelance of Necrotising periodontal diseases

A
  • Rare in industrialised countries-> common in developing
  • Occurs in children/young adults commonly
  • Occurs commonly in immunocompromised individuals

Affects all age groups

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6
Q

Clinical characteristics of Necrotising gingivitis

A
  • Ulcerated and necrotic papillae
  • Painful
  • Gingival margin w/ punched out appearance/cratered
  • Interproximal craters
  • Ulcers=>covered w/ yellowish white/greyish slough+Psuedomembranes of fibrin and necrotic tissue=>
  • Removal=>bleeding, exposure of underlying tissue and pain
  • Bleeding spontaneously
  • Swollen papillae w/ rounded contour
  • Linear erythema
  • Poor oral hygiene

-Pseudomembranes also contain leukocytes, erythrocytes, bacteria
-Lesions typically start at top of interdental papillae and migrate to involve whole gingiva
-Usually occurs in regions w/ chronic periodontitis
-Linear erythema between marginal necrosis and relatively unaffected gingiva

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7
Q

Necrotising periodontal diseases

Interproximal craters

A
  • Involved papillae=>facial and lingual portions=>
  • Necrotic depression between
  • Associated w/deep pocket formation
  • Gingival necrosis develops rapidly

-Gingival necrosis often coincides w/ loss off crestal alveolar bone

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8
Q

Necrotising periodontal diseases

Aveolar bone necrosis

A
  • Rapid in progession
  • Sequrestrum=> first irremovable then loosened and removeable w/ forceps
  • Very evident in immunocompromised patients
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9
Q

Necrotising periodontal diseases

Necrotising stomatitis

A
  • Necrosis progesses beyond MGJ
  • Immunocompromised patients and malnutrition
  • Bone denudation->sequestration, oroantral fistula and osteitis
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10
Q

Necrotising periodontal diseases

Additional symtoms of Necrotising periodontal diseases

A
  • Swelling of lymph nodes
  • Fever and malaise
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11
Q

Necrotising periodontal diseases

Swelling of lymph nodes

A
  • Regional lymph nodes in advanced cases
  • Submandibular and cervical especially
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12
Q

Necrotising periodontal diseases

Fever and malaise

A
  • Not characteristic but can occur
  • Elevation of temperature
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13
Q

Necrotising periodontal diseases

Oral hygiene

A
  • Poor and tooth brushing painful
  • Large amounts of plaque especially along gingival margin
  • Thin white film covering parts of attached gingiva

Film indicates patient havent cleaned area properly=>Composed of desquamated epithelial cells and bacteria in meshwork of salivary proteins

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14
Q

Necrotising periodontal diseases

Acute forms

A
  • Most prediminant presentation
  • Rapid destruction of periodontal tissue
  • Progesses to less painful chronic stage w/ attachment loss
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15
Q

Necrotising periodontal diseases

Chronic forms

A
  • Craters
  • Subgingival calculus and plaque
  • Acute ulcerative necrotic areas may disappear=>
  • Acute exacerbations can occur
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16
Q

Necrotising periodontal diseases

Necrotising periodontal diseases differential diagnosis

A
  • Primary hepatic Gingivostomatitis
  • Oral mucosal diseases
  • Leukemia=>more marked systemic symptoms

-PHG=>anywhere on free or attatched gingiva/alveolar mucosa, small ulcers on lips, tongue and buccally
-OMD=>Desquamative gingivitis, beign mucous membrane pemphigoid, erythema multiform exudativum, streptocossal gingivitis

17
Q

Microbiology in Necrotising periodontal diseases

A
  • Treponema sp
  • Selenomonas sp
  • Fusobacterium sp
  • HIV associated NPD-Borella
18
Q

Necrotising periodontal diseases aetiological factors

A
  • HIV infection
  • Malnutrion
  • Poor oral hygine w/ pre-existing gingivitis and history of NPD
  • Psychological stress and inaquequate sleep
  • Smoking and alcohol use
19
Q

Necrotising periodontal diseases

HIV infection

A
  • Impaired T-helper cells(CD4+) and T-suppressors(CD8+)=>impaired resistance to infection=>
  • Rapid progession of NPD
20
Q

Necrotising periodontal diseases

Malnutrition

A

*Protein malnutrition=>decreased resistance to infection

21
Q

Necrotising periodontal diseases

Treatment is divided into

A
  • Acute and maintainance phase treatment
22
Q

Necrotising periodontal diseases

Acute phase treatment

A
  • Eliminate disease activity=>scaling if possible
  • Hydrogen peroxide use
  • Chemical plaque control=>CHX 0.2% x2 daily
  • Antibiotics=>Metronidazole 250mg x3/day, penicillins, tetracyclines
  • HIV patients=>antimycotic->miconazole
  • Regular apppoitments and motivation

patient should use gentle burshing technqiue

Perio (60 decks)

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