Acute Perio Conditions

Question 1

what can NUG/NUP both be manifestations of?

Answer 1

HIV

Question 2

What is NUP?

Answer 2

extends into perio attachment
marker of severe immunosuppression that affects the gums and underlying bone
Is a unique side effect of AIDS

Question 3

NUG/ANUG are what type of infections?

Answer 3

endogenous infections

systemic changes predispose the gingiva to invasion by some bacteria in the oral flora

Question 4

who is Trench Mouth most common in?

Answer 4

16-30 year olds, males more common
5% incidence
seasonal variation

Question 5

Patient presents with?

Answer 5

pain, sudden onset, severe, may affect eating

Question 6

what do the necrotic ulcers of NUG present like?

Answer 6

initially are red swollen ID papillae. Ulceration starts at tip of papillae and spreads laterally along the gingival margin

Question 7

6 features of NUG

Answer 7

• grey pseudomembranous membrane slough - removed to display raw bleeding surface
• halitosis - foeter oris
• spont. bleeding
• metallic taste
• ID ulceration
• localised or generalised

Question 8

If NUG is severe what may it present with systemically?

Answer 8

lymphadenopathy

general malaise

Question 9

if NUG is not treated what happens?

Answer 9

acute symptoms last 2-3 weeks
heals as chronic gingivitis
tends to reoccur with further ID papillae loss - creates stagnation areas

Question 10

If NUG is not treated in a developing country what can happen?

Answer 10

can progress in malnourished or diseased children, can affect the facial tissues - oro facial necrosis
can cause cancrum oris - disfiguring/fatal

Question 11

what is the microbiology of NUG?

Answer 11

a fuso - spirochaetal complex

Question 12

what are the principle bacteria in NUG?

Answer 12

treponema vincentii and denticola
fusobacterium nucleatum
prevotela intermedia
porphromonas gingivalis

Question 13

what are some risk factors for NUG?

Answer 13

poor oh
smoking
stress
immunodeficiency

Question 14

how can smoking cause NUG?

Answer 14

• causes vasoconstriction - anaerobic conditions
• suppress serum IgG leveles against supragingival bacteria
• depresses T helper lymphocytes
• reduces motility and chemotaxis of PMNs

Question 15

how can stress cause NUG?

Answer 15

changes in behaviour - increased smoking, reduced oh care, reduced salivary flow, vasoconstriction in gingival end arteries, suppress immune response

Question 16

what is the histopathology of NUG?

Answer 16

• bacterial zone - surface slough rich in bac
• pmn rich zone - epithelium and supra CT rich in PMNs
• necrotic zone - mainly spirochaetes
• deeper tissues - still viable with plasma cells and macrophages
• some bacteria infiltrate

Question 17

how to treat NUG?

Answer 17

OHI and explanation
Gentle USS
antimicrobial metronidazole 200mg for 3 days
review 48 hours

Question 18

subsequent NUG tx?

Answer 18

OHI
smoking cessation
supra/sub debridement
review/maintenance
perio surgery to reverse architecture

Question 19

what kind of abscesses can occur?

Answer 19

periodontal
endodontic
combined

Question 20

what is an endodontic lesion?

Answer 20

toothache
occurs at apex of root, collection of pus under high pressure in small space. Enclosed infection. Very vascular - throbs. Discharging sinus can form through bone.

Question 21

what is a periapical granuloma?

Answer 21

benign tumour

sequale of something

Question 22

what is a combined lesion?

Answer 22

started in perio pocket as a perio abscess

travels down accessory canal = endodontic abscess - common in furcations

Question 23

what is a perio abscess?

Answer 23

needs an established perio pocket
blocked channel of moving bacteria = trapped area of virulent destructive bacteria
caused by scaling - calculus or trauma - inflammation - blocks pocket.
flush/rsd unless recent rsd has caused the abscess

Question 24

what is a gingival abscess?

Answer 24

outer layer of gingivae affected
caused by something causing trauma/infection in the gingival sulcus
e.g food/tb trauma = becomes infected

Question 25

what is pericoronitis?

Answer 25

infection of gingivae covering erupting teeth

hard to clean - bact/food stuck causing infection

Question 26

what are non plaque induced lesions?

Answer 26

specific bacterial origin/viral/fungal/genetic origin
gingival manifestations of systemic conditions
traumatic lesions
foreign body reactions and NOS

Question 27

specific bacterial origin lesions caused by?

Answer 27

• neisseria gonorrhea associated lesions
• treponema pallidium - syphillus/rare
• streptococcal species - viral infection. 2ndry colonises

Question 28

two types of primary herpetic gingivostomatitis?

Answer 28

HSV1 - STI type
HSV2 - caught from others - air particles, red gingivae and lips, common in kids, mouth and tongue ulcered, lies in trigeminal ganglia, lasts 1-2 weeks, becomes re active if cold/immunosuppressed etc as coldsores

Question 29

types of viruses causing lesions?

Answer 29

primary herpetic gingivostomatitis
recurrent oral herpes
varicella zoster infections - primary = chickenpox/secondary - shingles

Question 30

fungal infections causing lesions?

Answer 30

candida species infection
general g.candidosis
linear g.erythema
histoplasmosis - deep seated mycoses/rare/non specific ulceration

Question 31

genetic conditions causing lesions?

Answer 31

hereditary ginival fibromatosis

uncommon/autosmal dominant/general gingival enlargement/sometimes associated with epilepsy and mental retardations

Question 32

what are some gingival manifestations of systemic conditions?

Answer 32

lichen planus
pemphigoid
phemphigus vulgaris
erythema multiforme
lupus erythematosus
drug induced

Question 33

where could allergic reactions occur from?

Answer 33

dental restorative materials
mercury/nickel/acrylic etc
TP/MW/chewing gum additives/food additives