6 - Diagnosis and treating necrotising gingivitis/periodontitis Flashcards
1
Q
What are the main features of necrotising periodontal disease?
A
- painful bleeding gums
- ulceration and necrosis of papilla
- rapidly destructive and debilitating
- opportunistic infection caused by bacteria inhabiting health oral cavity
2
Q
Describe ANUG.
A
- acute necrotising ulcerative gingivitis
- non-contagious infection
- can become chronic or recurrent if left untreated
3
Q
Describe ANUP.
A
- 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
3
Q
Describe NS.
A
- necrotising stomatitis
- progression of ANUP beyond mucogingival junction
- can result in denudation (erosion) of bone and OAFs
- common in malnutrition and HIV
4
Q
What is cancrum oris?
A
- 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
5
Q
Describe the appearance of ANUG.
A
- ulcerated and necrotic papilla and gingival margin
- punched out appearance of papilla
- ulcers are yellowish/grey with slaim (sloughthing)
- lesions develop quickly
- severe pain
6
Q
How do you diagnose ANUG?
A
- bleeding readily provoked
- lesions first seen in lower anteriors interproximally
7
Q
What bacteria are commonly found in ANUG/P?
A
- 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
8
Q
What are the risk factors for developing ANUP?
A
- malnourished children (developed and developing countries)
- stress (developed countries)
- sleep deprivation (developed countries)
- poor OH (developed countries)
- smoking
- immunosuppression (HIV/leukaemia)
9
Q
What is the treatment of ANUG/ANUP?
A
- debridement
- antibiotics (metronidazole)
- chlorohexadine mouthwash if mechanical brushing too painful
- smoking cessation, dietary advice and vitamin supplementation
- if ANUP, HPT to follow
10
Q
What are the treatment strategies for managing ANUP?
A
- mechanical disruption
- systemic or local antibiotics
- host modulation therapy
11
Q
How is mechanical disruption of the biofilm achieved?
A
- OHI
- PMPR
12
Q
When are systemic antibiotics used to treat NPD?
A
- selected cases when combined with mechanical disruption of biofilm, after first round of RSD
- young people with grace B/C
13
Q
What antibiotics are prescribed for NPD?
A
- 400mg metronidazole x 3 daily for 3 days
- amoxicillin if allergy contraindicates
14
Q
What benefits do local antimicrobials have in treating NPD?
A
- 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
