6 - Diagnosis and treating necrotising gingivitis/periodontitis Flashcards
What are the main features of necrotising periodontal disease?
- painful bleeding gums
- ulceration and necrosis of papilla
- rapidly destructive and debilitating
- opportunistic infection caused by bacteria inhabiting health oral cavity
Describe ANUG.
- acute necrotising ulcerative gingivitis
- non-contagious infection
- can become chronic or recurrent if left untreated
Describe ANUP.
- acute necrotising ulcerative periodontitis
- infection leads to attachment loss
- likely that ANUP is the extension of ANUG into the PDLs
- ulcerated lesions associated with deep pockets
- swelling of lymph nodes in advanced cases
Describe NS.
- necrotising stomatitis
- progression of ANUP beyond mucogingival junction
- can result in denudation (erosion) of bone and OAFs
- common in malnutrition and HIV
What is cancrum oris?
- necrotising and destructive infection of mouth and face that can develop from ANUG (although most ANUG will not progress)
- usually occurs in malnourished children
- can be disfiguring and fatal
Describe the appearance of ANUG.
- ulcerated and necrotic papilla and gingival margin
- punched out appearance of papilla
- ulcers are yellowish/grey with slaim (sloughthing)
- lesions develop quickly
- severe pain
How do you diagnose ANUG?
- bleeding readily provoked
- lesions first seen in lower anteriors interproximally
What bacteria are commonly found in ANUG/P?
- spirochetas and fusobacteria are commonly found although not causative of primary lesions
- opportunistic infection by normal bacteria
- prevotella intermedia, treponema sp, selenomas sp are common too
What are the risk factors for developing ANUP?
- malnourished children (developed and developing countries)
- stress (developed countries)
- sleep deprivation (developed countries)
- poor OH (developed countries)
- smoking
- immunosuppression (HIV/leukaemia)
What is the treatment of ANUG/ANUP?
- debridement
- antibiotics (metronidazole)
- chlorohexadine mouthwash if mechanical brushing too painful
- smoking cessation, dietary advice and vitamin supplementation
- if ANUP, HPT to follow
What are the treatment strategies for managing ANUP?
- mechanical disruption
- systemic or local antibiotics
- host modulation therapy
How is mechanical disruption of the biofilm achieved?
- OHI
- PMPR
When are systemic antibiotics used to treat NPD?
- selected cases when combined with mechanical disruption of biofilm, after first round of RSD
- young people with grace B/C
What antibiotics are prescribed for NPD?
- 400mg metronidazole x 3 daily for 3 days
- amoxicillin if allergy contraindicates
What benefits do local antimicrobials have in treating NPD?
- reduced systemic dose
- high local concentration
- superinfections less likely
- drug interactions unlikely
- site specific
- compliance is not an issue as applied by HCW
- can be combined with chlorohexadine
When is using a PerioChip indicated?
- persisting pockets >5mm
- alongside RSD
- isolated pockets
- periodontal abscesses
Give examples of local antimicrobials.
- arestin (1mg minocycline HCl)
- atridox (doxycycline hyclate 10%)
- elyzol (25% metronidazole)
What are alternative treatments to manage NPD?
- Periostat (low dose doxycycline used systemically to inhibit the breakdown of collagen and therefore pockets)
- PerioWave (photosensitive solution is irrigated in socket and light used to activate and kill bacteria)
What are examples of host modulating therapy that can be used to manage NPD?
- corticosteroids
- NSAIDs
- biologic therapies
- lipid mediators
- bisphosphonates
