Diagnoses and Treatment of Necrotising Periodontal Disease Flashcards
What are the characteristics of necrotising periodontal disease?
Severe inflammation
Rapidly destructive
Due to shared predisposing factors eg students during exam time
Painful bleeding gums
Ulceration and necrosis of dental papilla
How are necrotising diseases classified?
Necrotising gingivitis - when only gingival tissues are affected
Necrotising periodontitis - when necrosis progresses into the PDL and alveolar bone, leading to attachment loss
Necrotising stomatitis - necrosis progresses to deeper tissues beyond the mucogingival line, including lip or cheek mucosa and tongue
How is necrotising periodontal disease diagnosed?
Based on symptoms
What are the symptoms of necrotising gingivitis?
Ulcerated and necrotic papillae and gingival margin - punched out appearance
Ulcers covered by yellowish, white or grey slaim
Lesions develop quickly, are very painful and bleed easily
What are the symptoms of necrotising periodontitis?
Ulcerations associated with deep pockets due to gingival necrosis and loss of crestal alveolar bone
Ulcers develop into craters
Adenopathies found in severe cases
What are the symptoms of necrotising stomatitis?
Bone loss extends through the alveolar mucosa
Larger bone sequestra may occur with areas of osteitis and OAF
What are the risk factors of necrotising periodontal disease?
Young adults with predisposing factors such as psychological stress, sleep deprivation, poor OH, smoking, immunosuppression, malnutrition
What are the treatment stages of the acute phase of necrotising periodontal disease?
Arrest the disease process and tissue destruction
Control the patient’s general feeling of discomfort and pain that is interfering with nutrition and OH
How is necrotising periodontal disease treated in the acute phase?
Daily careful superficial debridement to remove soft and mineralised deposits for as long as acute phase lasts (usually 2-4 days)
Mechanical OH measures limited - brushing wounds directly may cause pain and delay healing
Chemical plaque control formulations such as chlorhexidine mouthrinses twice daily
How should necrotising periodontal disease be managed if the acute phase is prolonged?
Antimicrobials - metronidazole 200mg 3x a day for 3 days
How should necrotising periodontal disease be treated after the acute phase?
Treatment of the pre-existing condition
Professional prophylaxis and/or scaling and root planing
OHI and motivation
Removal and treatment of existing predisposing local factors such as overhangs, interdental open spaces and tooth malposition
Control of systemic predisposing factors such as smoking, inadequate sleep, stress and dietary advice
What is the aesthetic consequence of necrotising periodontal disease?
Gingival craters
What are the treatment options for gingival craters and why is treatment necessary?
Gingivectomy/gingivoplasty procedures
Periodontal flap surgery
Regenerative surgery
Necessary as gingival craters can lead to plaque accumulation and disease recurrence
What is the goal of the supportive/maintenance phase of necrotising periodontal disease?
To comply with OH practices and control the predisposing factors
Why should patients with necrotising periodontal disease be screened for HIV?
The occurrence of necrotising periodontal disease in healthy individuals without any predisposing factors is suggestive of HIV infection
