advanced perio disease NG & NP Flashcards
who does necrotising gingivitis affect?
Can affect both males and females
Usually ages 18-30
Rare in the very elderly and very young
Can be very destructive
what is the clinical picture for necrotising gingivitis?
redness (erythema)
Oedema
Heat, pain and loss of function
Gingivae shiny with loss of stippling
Bleeds easily or spontaneously
Tips of interdental papilla affected with ulcers
May, if left untreated involve attached gingivae
Very painful, even on gentle probing (important diagnostic sign) covered in a layer of pseudomembranous slough (necrotic tissue), underlying tissue erythematous and raw
what is the slough called that the gingivae is covered in called?
pseudomembranous slough
what are symptoms of necrotising gingivitis?
halitosis - due to necrotic tissue
pain
patient may complain of a metallic taste in the mouth - due to bleeding
Upon healing-interdental papillae may have “punched out” appearance
May have cervical lymphadenitis-may affect submental and submandibular lymph nodes- Pyrexia and Malaise
how would you treat Necrotising gingivitis?
remove the pseudomembranous slough
SDCEP Guidelines – recommend if there is evidence of spreading infection or systemic involvement consider prescribing Metronidazole
Systemic antimicrobial treatment is sometimes indicated
Local treatment is essential
what factors can cause Necrotising gingivitis?
stress
poor diet
poor oh
smoking
pre existing gingivitis
what are some of the bacteria involved in NG?
gram negative
Fusospirochetal complex
Treponema Vincenti
Borelli Vincenti
Fusiform Bacilli
Porphyomonas Gingivalis
Fusobacterium Nucleatum
Prevotella Intermedium
what would patients feel during treatment for necrotising gingivitis or periodontitis? and what local treatment would you cary out?
remove pseudomembranous slough first
a fine scale - may feel tenderness throughout scale
low power setting on the cavitron
what systemic treatment would be given for Necrotising periodontitis?
Metronidazole is effective in eliminating the fusospirocheatal complex
200 mg 3x daily for 3 days
Contraindicated in first 3/12 of pregnancy and those who will not abstain from alcohol
Those on Warfarin – Metronidazole inhibits metabolism of warfarin in liver hence increase risk on uncontrolled bleeding.
Penicillin is suitable alternative
after initial treatment of Necrotising gingivitis has been carried out what would the next steps be?
After acute phase of NG has been treated address the other factors to reduce recurrence
what oral hygiene instruction would you give to someone with NG or NP?
Perhaps soft toothbrush initially –very tender to brush.
ID brush cleaning essential
Smoking cessation advice
Chlorhexidine after initial acute stage as it doesn’t penetrate the psudomembranous slough
smoking cessation advice such as - cutting down, vaping
what does necrotising periodontitis look like?
May have similar early presentation to NG, although lesion extends to affect periodontal attachment (more aggressive)
Possible involvement of alveolar bone
who is more at risk of NP?
HIV individuals are at known risk from NP
what are the signs of NG & NP with HIV patients?
Erythema
Punctuate Erythema: Small, pinpoint areas of redness.
Diffuse Erythema: Widespread redness affecting the entire gingival tissue.
Marked Erythema at Free Gingival Margin
The free gingival margin shows intense redness
Immune response to the bacteria associated with NG/NP.
what is the treatment for NP?
Might require referral to specialist
Necrotic tissue, loose bone sequestra, should be removed under L.A (surgery)
Metronidazole 200mg tid. x 3-7 days
