Chapter 8 Flashcards
What are the 3 types of necrotizing periodontal disease?
Necrotizing: gingivitis, periodontitis, stomatitis
May represent different stages of the disease
Typical features of necrotizing periodontal disease
-Tissue necrosis
-Spontaneous bleeding
-Pain inhibiting home care, eating and drinking
-Excessive salivation
-Foul odor present
-Initiates in papillary tissue
Characteristics of necrotizing gingivitis
Necrosis limited to gingival tissues
Cratered/punched out papillae
Yellowish-gray/whitish tissue slough
Spontaneous bleeding
Pain
Characteristics of necrotizing periodontitis
-Necrosis extending to the PDL and alveolar bone
-Rapid and destructive form of periodontitis that can produce attachment loss within days
Characteristics of necrotizing stomatitis
-Necrosis extending beyond the gingiva to areas like the tongue, cheek and palate
-Bone stripping can occur through the alveolar mucosal tissue
-Most rare and severe form
Alternate terminology
Trench mouth
Vincent’s infection/stomatitis
ANUG
NUP
Why is the term “ulcerative” no longer used?
Ulceration is secondary to tissue necrosis
What is a pseudomembrane in PD?
-Grayish, yellow-white tissue slough over necrotic areas
-Consists of fibrin with leukocytes, erythrocytes and bacteria
-Not a true membrane
How do interproximal craters form?
Within days the lingual papilla separate and a crater forms under the contact
Once formed, destruction invades the PDL and AB in NP.
Difference in attachment loss between regular and necrotizing periodontal disease?
Necrosis results in recession rather than deep pockets
Systemic characteristics of NPD
Submandibular and cervical lymphadenopathy
In sever stages: high fever, malaise, increased pulse and loss of appetite
Etiology of NPD
Diminished host response
Bacterial: Treponema, Selenomonas, Fusobacterium, Prevotella intermedia
Predisposing factors for NPD
-Emotional stress, fatigue, poor nutrition
-Cigarettes and alcohol use
-Caucasian
-Poor plaque control
-North American college students
-Developing countries- young children, poor nutrition, insufficient protein
Treatment for NPD at visit 1
-Remove pseudomembrane
-Gentle subgingival instrumentation
-Gentle homecare
-Fluids, rest, avoid cigarettes and alcohol
-NSAIDs, chlorhexadine, hydrogen peroxide/H2O
Treatment for NPD at visit 2 (2 days later)
Subgingival instrumentation
Control contributing factors
Treatment for NPD at visit 3 (5 days after first visit)
Complete instrumentation
Comprehensive perio evaluation: determination of further therapy
Mucogingival conditions and deformities
-Periodontal biotype
-Gingival/soft tissue recession
-Lack of keratinized gingiva
-Decreased vestibular width
-Aberrant frenum/muscle position
-Gingival excess
-Abnormal color
Periodontal biotypes
Thin scalloped
Thick scalloped
Thick flat
Gingival soft tissue recession concerns
Facial or lingual surfaces?
Interproximal
Severity of recession
Gingival thickness/width
Cervical lesions (carious and noncarious)
Esthetic concerns
Hypersensitivity
Types of gingival excess
Pseudopocket
Inconsistent gingival marginExcessive gingival display
Gingival enlargement
Characteristics of Cairo classification recession type 1
No loss of interproximal attachment
CEJ not clinically detectable at mesial or distal
Direct facial or lingual recession only
Characteristics of Cairo classification recession type 2
-Interproximal attachment loss (depth of pocket) is less than or equal to the buccal attachment loss (depth of pocket)
-Associated with horizontal BL
Characteristics of Cairo classification recession type 3
-Interproximal attachment loss is greater than buccal attachment loss
-Severe horizontal BL and usually associated with interproximal intrabony pocket
Characteristics of Miller Classification Class I
-Marginal tissue recession that does not extend to the MGJ
-No interproximal bone or tissue loss
Characteristics of Miller Classification Class II (deep)
-Marginal recession extends to or beyond the MGJ
-No interproximal bone or tissue loss
Characteristics of Miller Classification Class III
-Marginal recession extends to or beyond MGJ
-Interdental bone/soft tissue loss or malpositioned teeth
Characteristics of Miller Classification Class IV
-Marginal tissue recession extends to or beyond the MGJ
-Severe interproximal bone loss
