Diagnosis and Treatment of Necrotising Periodontal Diseases Flashcards
what are characteristics of necrotising periodontal diseases
rapidly destructive
painful, bleeding gyms and ulceration and necrosis of interdental papilla
what type of disease is NPD
opportunistic infection - bacteria inhabiting a healthy oral cavity
what are the classifications of NPD
necrotising gingivitis
necrotising periodontitis
necrotising stomatitis
what is necrotising gingivitis
constricted to soft tissue and gingiva
clinical attachment loss is not present
bone is not involved
what is necrotising periodontitis
infection leads to loss of attachment and bone loss
what is necrotising stomatitis
the infection spreads to alveolar bone - leading to destruction of alveolar bone and can create OAFs
what is cancrum oris
necrotising and destructive infection of mouth and face
seen in malnourished children
disfiguring and can develop from NG
what are the old terms for NG and NP
ANUG - acute necrotising ulcerative gingivitis
ANUP - acute necrotising ulcerative periodontitis
how is necrotising diseases diagnosed
by symptoms
why are the diagnoses for necrotising diseases not based on tests
histopathology is not pathognomic
the bacteria taken from a biopsy or swab would just be normal bacteria
what symptoms would give a diagnosis of necrotising gingivitis
ulcerated and necrotic papilla
punched out appearance of papilla
ulcers are covered with yellow/ white/ grey slaim
lesions develop quickly and are very painful
what is the pseudomembrane in NG
yellow/ white/ grey slaim
there is no coherence, just accumulation of fibrin, necrotic tissue and bacteria
what are ulcerations in NP associated with
deep pocket formation
what do ulcers with central necrosis develop into in NP
craters
what does lack of a fever mean for diagnosis
it is not herpetic gingivostomatitis
what occurs in necrotising stomatitis
the bone destruction extends through the alveolar mucosa
what is the difference between NP and herpetic gingivostomatitis
NP caused by bacteria, HG caused by herpes simplex virus
HG is mostly in children
NP is usually just in the interdental papilla and HG affects the entire oral mucosa
since NPDs are opportunistic infections what are risk factors
developed countries - psychological stress, sleep deprivation, poor OH, smoking, immunosuppression
developing countries - malnourished children
what is the two main objectives in treatment in the acute phase of NPDs
arrest the process and tissue destruction
control the patients general feeling of discomfort and pain
what is the first phase of treatment for NPDs
superficial debridement - should be carried out daily for the whole of the acute phase (2-4 days)
what is the second phase of treatment for NPDs
mechanical oral hygiene measures should be limited - because brushing directly in the wounds may impair healing and induce pain
what should the patient be encouraged to use in the acute phase
chemical plaque control - chlorhexidine- based mouthwashes (0.2%) daily
what treatment should be provided if no improvement is seen after the acute phase or if there is systemic involvement
prescribe antibiotics
metronidazole 400mg TID for 3 days
why is diluted hydrogen peroxide solution and drugs like metronidazole more effective in treating NPDs
because of the anaerobic bacteria
what should the patients be informed as their symptoms and signs improve
strict mechanical hygiene measures should be enforced
complete debridement of the lesions
how should you treat the pre-existing conditions of NPDs
professional prophylaxis
root planing
scaling
OHI
improve local predisposing factors
what are the major problems of NPDs
creation of craters which then plaque can accumulate in - consider flap surgery
what should you check if a patient has NPD but has no local or systemic factors they are aware of that would be causing it
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