Diagnosis and tx of necrotising gingivitis/periodontitis Flashcards
What are the different diagnosis of necrotising gingivitis periodontitis
necrotising periodontal disease NPD
necrotising gingivitis NG
necrotising periodontitis
necrotising stomatitis NS
acute necrotising ulcerative gingivitis ANUG
acute necrotising ulcerative periodontitis ANUP
fusospirochetosis
trench mouth
vincent’s gingivitis, gingivostomatitis, infection
What are the main features of NPD
painful, bleeding gums and ulceration and necrosis of the interdental papilla
rapidly destructive and debilitating
Why is ANUG/P known to occur in epidemic type patterns
due to shared predisposing factors in a population
it is not contagious
What type of infection is necrotising gingivitis/periodontitis
opportunistic infection - caused by bacteria inhabiting healthy oral cavity
What is acute necrotizing ulcerative gingivitis
ANUG
or simply necrotizing gingivitis
common non contagious infection of gums
if improperly treated can become chronic and or recurrent
What is NUP/NP/ANUP
this is when the infection leads to attachment loss
it may be the extension of NUG into the periodontal ligaments although this is not completely proven
it may be that both diseases develop without connection
What is necrotizing stomatitis
progression of NUP into tissue beyond the mucogingival junction and
may result in denudation of the bone leading to osteitis and oro-antral fistulas
Who is necrotizing stomatitis mostly seen in
those with malnutrition dn HIV infection
What is cancrum oris (aka norma)
necrotizing and destructive infection of the mouth and face and therefore not strictly speaking a periodontal disease
in modern times it usually occurs in malnutrition children in developing countries
What is the diagnosis based on
symptoms
What is the diagnostic symptoms
ulcerated and necrotic papillae and gingival margin resulting in characteristic punched out appearance
the ulcers are covered by a yellowish, white or grayish slough
lesions develop quickly
lesions are very painful - severe pain
What are the symptoms
bleeding readily provoked
first lesions most often seen inter proximally in mandibular anterior region
in NUP the ulcerations are often associated with deep pockets formation as gingival necrosis coincides with loss of crystal alveolar bone
swelling of the lymph nodes particularly in the advanced cases
usually no elevation of body temperature - herpetic gingivostomatitis
Why is the diagnosis not based on any test
as if u took a biopsy the histopathology is not characteristic for NPD
microbiology - not characteristic
it is an opportunistic infection
What are risk factors for NPD
mostly young adults with predisposing factors such as stress, sleep deprivation, poor OH, smoking and immune supression and/r malnutrition
In developing country who does ANUG mostly occur in
malnourished children
What makes clinical characteristic of HIV px different to the normal ones
not associated with big amounts of plaque and calculi
What is the tx
tx of the acute disease is debridement and AB - usually metronidazole
need to get good OH
- ultrasonic debridement
- if painful on brushing use 0.2% chlorhexidine moutwash
- for those with systemic symptoms, lack of response and with impaired immunity then 200mg metronidazole TID
- smoking cessation, vitamin supplementation, dietary advice
- in case of necrotising periodontitis, after emery of acute symptoms need to carry out HPT to treat periodontal disease
What are the tx strategies for periodontal disease
mechanical disruption
systemic abitbioticss or local antimicrobias
host modulation therapy
What is mechanical disruption
reducing the bacterial challenge
scaling and root surface debridement
targeting biofilm
What are systemic antibiotics or local antimicrobials targeting
biofilm
What is host modulation therapy
targeting function of the immune system
Why are systemic AB not the first line of tx
we are fighting a biofilm
If prescribing AB what must they be used w
mechanical disruption
When can we consider treating with systemic AB with mechanical disruption
in cases of young people with grade B/C (fast progressing periodontitis)
What is the tx protocol for those px that need the Ab
- OH
- supra gingival scaling and RSD of all sites indicated in pocket chart
- start the antibiotic regiment on the morning of the first RSD visit
- 500mg amoxicillin with 200mg metronidazole TID 7 days
OR
400mg metronidazole TID 7 days for those allergic to amoxicillin
What are advantages of local antimicrobials
reduced systemic dose
high local concentration
superinfection such as c difficile unlikely
drug interactions unlikely
site specific
px compliance not an issue as applied by healthcare provider
can utilize agents that can’t be utilized systemically e.g chlorhexidine
What are the indications for using local antiseptics
only persisting pockets
always with RSD
only in isolated pockets
in case of periodontal abscess after evacuation of pus and RSD
What are the possible host modulation therapies
corticosteroids NSAID anticytokine and biologi therapies lipid mediators of resolution of inflammation small molecule compounds bisphosphonates
