Acute Gingival Infections Flashcards by Haris Memon

Acute gingival infections are?

Acute gingival infections are
1. Acute necrotizing ulcerative gingivitis
2. Acute herpetic gingivostomatitis
3. Acute pericoronitis

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ANUG

NUG is microbial disease of gingiva in which there is necrosis and sloughing of gingival tissue

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is always acute there is no chronic form that’s why it is also called acute necrotizing ulcerative gingivitis

NUG

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oNSET OF ANUG IS

20-30 YEARS

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wHY Nug usually does not forms periodontal pocket formation

because necrosis changes involves gingival and junctional epitheleum,while healthy periodontium needed for pocket formation.

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5 Clinical symptoms of ANUG

1.NUG is sensitive to touch.
2.Patients always complains constant radiating and gnawing pain.
3.Intensity of pain is increased while having spicy and hot foods chewing.
4.Metallic foul taste.
5.Excessive amount of pasty saliva.

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7 Oral Signs of ANUG

1.Lesions are punched out crater like depression at the crest of interdental papillae.
2.It may extend to marginal gingiva and rarely to attach gingiva or oral mucosa.
3.Surface of disease is covered by grey,pseudomembranous slough and is demarcated from remainder gingival mucosa by pronounced linear erythema.
4. Some times lesion is denuded exposing margins red, shiny and hemorrhagic.
5.Spontaneous hemorrhage and bleeding on slight stimulation.
6.Fetid odor
7.Increased salivation.

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Extraoral sign and symptoms of ANUG?

Mostly pts have minimum systemic symptoms in mild cases like
a.Local lymphadenopathy
b.Slight elevation of temperature.
2.In severe cases patients have
a.High grade fever
b.Increased pulse rate
c. Leukocytosis
d.Lossof appetite

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Systemic rxns of ANUG in children are?

systemic reactions are severe in children.
ig.insomnia,constipation,gastrointestinal disorders, headache and mental depression may occurs some times.
.Rarely very severe conditions like gangrenous stomatitis and noma may occurs.

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Clinical course of ANUG?

1.Severity of NUG often diminishes without treatment,
Leading subacute stage with mild symptoms.
2.Some patients experience repeated remissions with exacerbations,
condition can reoccur in previously treated patients.
3.If untreated NUG condition can be worse like NUP and noma.

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Etiology Of ANUG?

BACTERIA
IMPAIRED HOST.
PREDISPOSING FACTORS (LOCAL AND SYSTEMIC FACTORS)
PSCHOLOGICAL DISTRUBANCES.

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Bacterial cause?

Fusospirochetal complex like
1.T.microdentium
2.intermedia spirochetes
3.vibrios
4.fusiform bacilli
5.Borrelia species

'’Tiny Intelligent Vampires Feast Blood’’

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3 local predisposing factors for ANUG?

Pre existing gingivitis
Smoking
Gingival trauma

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2 Systemic factors for ANUG?

1.nutritional deficiencies like
A. vitamin c deficiency
B. vitamin B deficiency
2. Chronic disease like
A. Gastrointestinal disease
B. Blood disorders

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Histopathology of ANUG?

Surface epithelium is destroyed and replaced by meshwork of fibrin, necrotic epithelial cells ,polumorphonuclear leukocytes predominantly neutrophils and various types of microorganisms.

Connective tissue is hyperemic with numerous engorged capillaries and dense infiltration of PMNs ,this acute inflamed zone appears clinically as the linear erythema beneath the surface pseudo membrane.

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4 Zones of ANUG?

ZONE1.Bacterial zone
ZONE2.Neutrophilic rich zone.
Zone3.necrotic zone.
ZONE4.Spirochetal infiltration zone.

BNNB

Stages Of ANUG?

STAGE1.Necrosis of tip of interdental papilla
STAGE2.Necrosis of whole papilla
STAGE3.Necrosis of marginal gingiva
STAGE4.Necrosis extending attached gingiva
STAGE5.Necrosis extending into buccal or lingual mucosa
STAGE6.Necrosis exposing alveolar bone
STAGE7.Necrosis perforating skin of cheek

DD Of ANUG?

D/D means resembles in some respect such as
1.Herpetic gingivostomatitis
2.chronic periodontitis
3.Desquamative gingivitis
4.Streptococal gingivostomatitis
5.Apthous stomatitis
6.Gonococal gingivostomatitis
7.diphtheritic and syphilitic lesions
8.Tuberculous gingival lesions
9.Candidiasis
10.Agranulocytosis and dermatoses( pemphigus and lican plannus)

3 Visit treatment of ANUG?

IST VISIT
Elevation of acute symptoms by reducing microbials load
1.apply topical anesthetic gel and remove supra gingival calculus by scaling
2.Remove necrotic tissue with cotton pallets(debridement of dead tissue to allow healing)
3.Prescribe antibiotics and anti inflammatory drugs and topical anesthetic gels
4.Advise patient to rinse with 3% hydrogen peroxide mouth wash along with warm water every 2 hours
5.Advise patient rinse with chlorohexidine gluconate mouth wash twice day
6.Advise patient to stop smoking and alcohol intake if he uses.

SECOND VISIT
Re evaluation and scaling done if necessary

THIRD VISIT.
Hydrogen peroxide discontinue if necessary scaling should be done

4 Nicknames of ANUG?

Trench mouth
Vincent stomatitis
Vincent angina
Fetid stomatitis

Define Pericoronitis?

Pericoronitis is a inflammation of gingiva or peri coronal portion of gingiva in relation to the crown of an incomplete erupted tooth.
Mostly occurs in mandibular third molars

Etiology Of Pericoronitis?

1.Bacteria
2.Truama Of Opperculum due to occlusion
3.Forein body entrappement in flap

Types Of Pericoronitis?

1.Acute
2.Subacute
3.Chronic

Clinical Features Of pericoronitis?

Red ,swollen ,suppurative lesion of operculum.

Tenderness

Pain is radiating to ear ,throat and floor of mouth

Foul test

Inability to close jaw

Swelling of cheek in the region of angle of jaw

Acute condition there is trismus of jaw

Patient may have systemic manifestation in acute conditions like fever ,leukocytosis , lymphadenopathy and malaise.

Complications of pericoronitis?

Acute peri coronal abscess Trismus Cellulitis Ludwig angina

Treatment Of Pericoronitis?

Acute phase to subacute cleaning an irrigation of operculum to remove any foreign body and flush out microbes to reduce microbial load . Prescribe antibiotics, anti inflammatory along with chlorohexidine mouth rinse . When acute symptoms subside advise patient to remove operculum or extraction of tooth.

Define Acute Herpetic Gingivo Stomatitis?

*Acute herpetic gingivostomatitis is viral infection of oral cavity caused by herpes simplex virus(HSV),characterized by discrete ,spherical ,gray vesicle formation on gingiva and labial and buccal mucosa ,soft palate ,pharynx ,sublingual mucosa and tongue.

Unlike ANUG Most often occurs ---------- of age

infants and children below 6 years of age

Coarse of disease is limited to----------

7 to 10 days.

Secondary manifestation is due to--- and what it is ? in Acute herpetic gingivostomatitis?

Secondary manifestations result from various stimuli like sunlight ,trauma , fever ,and stress. *Secondary manifestations includes herpes labials

Oral Signs Of Acute herpetic gingivostomatitis?

*Disease appears as diffuse ,erythematous shiny involvement of gingiva and oral mucosa with various degree of bleeding and edema . * Initial lesion appears as discrete ,spherical ,gray vesicles *Occurs on gingiva ,labial and buccal mucosa ,pharynx ,sublingual mucosa and tongue. *After 24 hours these vesicles ruptures and forms painful small ulcers with red ,elevated halo-like margins and depressed yellowish or grayish white central portion. *Occasionally it occurs without vesiculation clinical pictures shows diffuse ,erythematous shiny discoloration and edematous enlargement of gingiva with tendency to bleed.

Oral Symptoms?

😡🙄🤦‍♂️🤷‍♂️👿🍽️ Generalized soreness of mouth. *Difficulty in eating drinking and maintain oral hygiene due to soreness of mouth *Rupture vesicles are sites of pain. *Sensitive to touch ,thermal changes and foods such as condiments and fruit juices. *Children becomes irritable and refused to eat food.

ExtraOral Sign and symptoms of Acute herpetic gingivostomatitis?

*Cervical lymphadenopathy. *High grade fever ranges from 101 F to 105F *Generalized malaise

Histopathology Of Acute herpetic gingivostomatitis?

Virus targets epithelial cells called Tzanck . *These cells shows ballooning degeneration , * Infected cells fused to form multinucleated cells and intercellular edema leads to formation of intra epithelial vesicles that rupture and develop secondary inflammatory response with fibro purulent exudate. *Rupture ulcers shows acute inflammation in central portion with various degree of purulent exudate surrounded by swollen blood vessels.

DD Of AHGS

*Recurrent aphthous stomatitis. *Erythema multiform. *Bullous lichen planus. *Desquamative gingivitis’

t/f *Primary herpetic is contagious disease

Treatment of Acute Herpetic Gingivostomatitis?

Antiviral drugs like Acyclovir *Anti-inflammatory agents to reduce pain *Topical anesthetic gels * If secondary infected prescribe antibiotics