Acute Periodontal Conditions Flashcards
What are the two types of necrotising periodontal diseases?
Necrotising ulcerative gingivitis
Necrotising ulcerative periodontitis
What is NUP thought to be related to?
Unique side effect of AIDS
Marker of severe immunosuppression
What type of infection is NUG?
Endogenous infection
Systemic change predispose the gingiva to bacterial invasion
16-30 age range
Incidence of male to female equal
Describe clinical features of NUG
Sudden onset and pain Necrotic ulcers- starting at tips of papilla- spreads laterally Grey pseudo membranous Slough Halitosis- foetor oris Flattening of Papilla Spontaneous bleeding Metallic taste Can be localised or generalised If severe lymphadenopathy and general malaisea
What happens is NUG not treated?
Acute symptoms for 2-3 weeks
Heals to leave chronic gingivitis
Reoccurs with further flattening of papilla
Leaves stagnation areas
In develope countries
Oro facial necrosis
Canrun oris
Facial disfigurement or fatality
Describe the microbiology of NUG
Anaerobic fuso spirochaetal complex
Treponema Vincentii and denticola
Fucobacterium nucleatum
Porphyromonas gingivalis
Prevotella intermedia
What are the predisposing factors for NUG
Poor oh
Smoking
Stress
Immunodeficiency
What are the links to NUG and smoking?
Worse oh in smokers Vasoconstriction re anaerobic bacteria IgG Levels decreased against sub gingival bacteria Depressed help T lymphocytes Reduced motility and chemotaxis of PMNs
Describe the links to NUG and stress
Changes to behaviours- more smoking and poor oh
Reduced salivary flow
Vasoconstriction in gingival arteries
Suppressed immune response
Describe the histopathology of NUG
Bacterial zone- surface slough +++ bacteria
PMN rich zone- epithelium +++ PMNs
Necrotic zone- many bacteria- spirochaetes
Deeper tissues- still viable - plasma cells and macrophages
Describe treatment of NUG
OHI and explanation
Gentle uss under LA if required and prescribed
Metronidazole 200mg for 3 days
48 hour review
What subsequent treatment should be offered re. NUG.
OHI
Smoking cessation
Sub and supra debridement
Review and maintenance
What are the three main groups of abscess
Periodontal
Endodontic
Combined
Describe how a combined abscess can occur
Bacteria enters via accessory canals from periodontium as well as through dentinal tubules from a carious lesion
