Acute Perio Conditions Flashcards
what can NUG/NUP both be manifestations of?
HIV
What is NUP?
extends into perio attachment
marker of severe immunosuppression that affects the gums and underlying bone
Is a unique side effect of AIDS
NUG/ANUG are what type of infections?
endogenous infections
systemic changes predispose the gingiva to invasion by some bacteria in the oral flora
who is Trench Mouth most common in?
16-30 year olds, males more common
5% incidence
seasonal variation
Patient presents with?
pain, sudden onset, severe, may affect eating
what do the necrotic ulcers of NUG present like?
initially are red swollen ID papillae. Ulceration starts at tip of papillae and spreads laterally along the gingival margin
6 features of NUG
- grey pseudomembranous membrane slough - removed to display raw bleeding surface
- halitosis - foeter oris
- spont. bleeding
- metallic taste
- ID ulceration
- localised or generalised
If NUG is severe what may it present with systemically?
lymphadenopathy
general malaise
if NUG is not treated what happens?
acute symptoms last 2-3 weeks
heals as chronic gingivitis
tends to reoccur with further ID papillae loss - creates stagnation areas
If NUG is not treated in a developing country what can happen?
can progress in malnourished or diseased children, can affect the facial tissues - oro facial necrosis
can cause cancrum oris - disfiguring/fatal
what is the microbiology of NUG?
a fuso - spirochaetal complex
what are the principle bacteria in NUG?
treponema vincentii and denticola
fusobacterium nucleatum
prevotela intermedia
porphromonas gingivalis
what are some risk factors for NUG?
poor oh
smoking
stress
immunodeficiency
how can smoking cause NUG?
- causes vasoconstriction - anaerobic conditions
- suppress serum IgG leveles against supragingival bacteria
- depresses T helper lymphocytes
- reduces motility and chemotaxis of PMNs
how can stress cause NUG?
changes in behaviour - increased smoking, reduced oh care, reduced salivary flow, vasoconstriction in gingival end arteries, suppress immune response
what is the histopathology of NUG?
- 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
how to treat NUG?
OHI and explanation
Gentle USS
antimicrobial metronidazole 200mg for 3 days
review 48 hours
subsequent NUG tx?
OHI smoking cessation supra/sub debridement review/maintenance perio surgery to reverse architecture
what kind of abscesses can occur?
periodontal
endodontic
combined
what is an endodontic lesion?
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.
what is a periapical granuloma?
benign tumour
sequale of something
what is a combined lesion?
started in perio pocket as a perio abscess
travels down accessory canal = endodontic abscess - common in furcations
what is a perio abscess?
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
what is a gingival abscess?
outer layer of gingivae affected
caused by something causing trauma/infection in the gingival sulcus
e.g food/tb trauma = becomes infected
what is pericoronitis?
infection of gingivae covering erupting teeth
hard to clean - bact/food stuck causing infection
what are non plaque induced lesions?
specific bacterial origin/viral/fungal/genetic origin
gingival manifestations of systemic conditions
traumatic lesions
foreign body reactions and NOS
specific bacterial origin lesions caused by?
- neisseria gonorrhea associated lesions
- treponema pallidium - syphillus/rare
- streptococcal species - viral infection. 2ndry colonises
two types of primary herpetic gingivostomatitis?
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
types of viruses causing lesions?
primary herpetic gingivostomatitis
recurrent oral herpes
varicella zoster infections - primary = chickenpox/secondary - shingles
fungal infections causing lesions?
candida species infection
general g.candidosis
linear g.erythema
histoplasmosis - deep seated mycoses/rare/non specific ulceration
genetic conditions causing lesions?
hereditary ginival fibromatosis
uncommon/autosmal dominant/general gingival enlargement/sometimes associated with epilepsy and mental retardations
what are some gingival manifestations of systemic conditions?
lichen planus pemphigoid phemphigus vulgaris erythema multiforme lupus erythematosus drug induced
where could allergic reactions occur from?
dental restorative materials
mercury/nickel/acrylic etc
TP/MW/chewing gum additives/food additives
