Diagnosis and treatment of necrotising periodontal diseases Flashcards
What factors contribute to the rapid and debilitating nature of necrotising periodontal diseases (NPD), and how do these diseases impact certain populations?
NPD is highly destructive due to plaque bacteria in the presence of predisposing factors like stress, poor hygiene, and immunosuppression, occurring in epidemic-type patterns among populations such as students under stress or military recruits.
Why are necrotising periodontal diseases sometimes mistakenly considered contagious, and what disproves this belief?
The epidemic patterns of NPD in specific populations can mimic contagious spread; however, it results from shared environmental and health factors rather than direct person-to-person transmission.
Define the progression of tissue involvement in necrotising gingivitis, necrotising periodontitis, and necrotising stomatitis.
Necrotising gingivitis affects only the gingiva, necrotising periodontitis extends into the periodontal ligament and alveolar bone causing attachment loss, and necrotising stomatitis advances beyond the mucogingival line, potentially causing bone exposure.
What are the unique characteristics and risks of necrotising stomatitis, particularly in patients with severe malnutrition or HIV?
Necrotising stomatitis can result in extensive tissue necrosis, bone denudation, osteitis, and oro-antral fistulas in severely immunocompromised individuals, often requiring aggressive medical management.
Describe the “punched-out” appearance of interdental papillae in necrotising gingivitis and its implications for diagnosis.
Unique appearance: papillae look as if parts are missing
Key diagnostic clue along with:
Severe pain
Bleeding
Pseudomembrane presence
What is a pseudomembrane, and why is its terminology misleading in necrotising gingivitis?
Necrotic tissue
Fibrin
Leukocytes
Bacteria
Not a true membrane—it’s loosely attached and easily removed
Explain how necrotising periodontitis leads to alveolar bone loss and the formation of deep pockets.
Necrotising periodontitis progresses into the periodontal ligament and bone, causing necrosis that coincides with loss of alveolar bone and the development of deep pockets.
What is the significance of submandibular adenopathy in necrotising periodontitis?
Submandibular lymph node involvement, more common in severe cases, suggests an advanced systemic inflammatory response to the infection, which differentiates it from less severe periodontal conditions.
In necrotising stomatitis, how does disease progression differ from necrotising gingivitis and periodontitis?
Necrotising stomatitis progresses beyond the gingiva to involve deeper oral tissues and the mucosa, leading to severe complications like bone sequestration and potential oral–antral fistula formation.
Why are malnourished or HIV-positive individuals at higher risk for necrotising stomatitis, and what are the typical outcomes in these populations?
Their immune systems are compromised, allowing deeper infection and bone denudation, which can result in significant disfigurement, severe pain, and increased mortality risk.
How did historical terms like “Trench Mouth” and “Vincent’s Gingivitis” contribute to early understanding and treatment of necrotising periodontal diseases?
“Trench Mouth”: Common in WWI soldiers
“Vincent’s Gingivitis”: Linked to fusospirochaetal bacteria
Outdated due to lack of specificity
Why is necrotising gingivitis primarily diagnosed based on symptoms rather than specific tests?
Clinical symptoms like punched-out papillae, pain, and characteristic pseudomembrane are distinctive enough for diagnosis, while histopathology and microbiology lack unique markers for NPD.
Describe the role of “foetor ex ore” in diagnosing necrotising gingivitis.
Foul smell due to:
- Tissue necrosis
- Bacterial activity
Aids diagnosis
Why are biopsies and microbial tests not definitive for diagnosing necrotising periodontal diseases?
Show non-specific inflammation
Bacteria (e.g., Treponema, Fusobacterium) found in healthy mouths too
What are some conditions that mimic necrotising periodontal diseases, and how can they be differentiated?
- Herpetic gingivostomatitis
- Oral mucositis
Differences:
History
Systemic symptoms
Lesion characteristics
Why is it crucial to differentiate necrotising periodontal diseases from conditions like leukemia or HIV-associated periodontitis?
Need different diagnostic workup and management
What are the primary risk factors for necrotising periodontal diseases in developed versus developing countries?
In developed countries, stress, poor hygiene, smoking, and immunosuppression are common risk factors, while malnutrition is the predominant factor in developing countries.
How does the clinical presentation of necrotising periodontal diseases in HIV-positive patients differ from those who are HIV-negative?
In HIV-positive patients, lesions appear with less plaque and calculus accumulation, and are often more severe due to immunosuppression.
Outline the immediate objectives of treatment during the acute phase of necrotising periodontal diseases.
Arrest disease
Minimize tissue loss
Alleviate pain
Enable oral hygiene restoration
What is the role of debridement in managing necrotising periodontal diseases, and why is it performed gradually?
Debridement removes bacteria-laden deposits, essential for healing. It is performed with minimal pressure initially to avoid further trauma and increase patient tolerance as healing progresses.
Why might systemic antimicrobials like metronidazole be preferred in cases with systemic involvement in NPD?
Metronidazole
Preferred for:
- Deeper penetration
- Better reach in systemic involvement
What is the role of corrective procedures like gingivoplasty in managing post-NPD aesthetic issues, and how do these procedures prevent disease recurrence?
Reshapes gingival craters post-healing
Reduces plaque traps → prevents recurrence
Why is patient compliance essential during the maintenance phase of NPD treatment, and what factors must be controlled?
Compliance with oral hygiene and managing predisposing factors (e.g., stress, diet) are crucial to prevent relapse, as lingering risk factors can lead to recurrence of NPD.
Why should individuals with NPD without known risk factors be screened for HIV, and what does this suggest about NPD as a diagnostic marker?
Unexplained NPD may signal underlying immunodeficiency
HIV screening advised if:
No risk factors present
Lesions are unusually severe
