Exam 2 part 2 Flashcards
What are the bacteria involved in both NUG and NUP
P. intermedia, Spirochetes, Fusiformbacteria
What kind of tissue is involved in NUG
Involves both stratified squamous epithelium & underlying CT
Define NUG
Acute necrotizing inflammation of the gingival margin
Is NUG contagious?
No
What is another name for NUG and why was that made popular?
Trench mouth
1914 WWI, WWII
Age groups that NUG occurs in
Occurs in all ages but mainly 20-30
Visually what do you see in NUG
Forms Pseudomembrane
- Replaces destroyed epithelium
- Meshwork of fibrin, necrotic epithelial cells, PMN’s and various microorganisms
Clinical features of NUG
- Rapid onset
- Severe pain
- Gingival bleeding; may or may not be spontaneous
- Interdental Crater, punched put papilla, PSEUDOMEMBRANE, fetid (sulfur) breath
Etiology - Host Response of NUG
Systemic predisposing factors Immunosuppression - AIDS Stress Smoking Diet
Etiology - Oral Hygiene of NUG
Pre-existing gingivitis
Opportunistic microorganisms
Main Etiology of NUG
Microorganisms - P. intermedia, Spirochetes, Fusiformbacteria Other Factors - Host resistance + smoking - Oral hygiene - Local irritants
In what zone is NUG of the Listgarten’s 4 zones
Zone 4: Zone of spirochetal infiltration
- Well-preserved tissue infiltrated with spirochetes
Describe the pseudomembrane feature of NUG
Replaces destroyed epithelium
Meshwork of fibrin, necrotic epithelial cells, PMN’s, and various microorganisms
Treatment of NUG
- First visit - debridement, OHI
- Evaluate systemic factors
- Recall visit - 1-2 weeks, eval. OH, further tx
- Final re-eval - 4-6 wks, consider surgery
- If fever present give antibiotics first: Amoxicillin and Metronidazole
Extraoral and systemic signs and symptoms of NUG
- Slight elevation in temperature
- Local lymphadenopathy
- Patients usually ambulatory with no systemic complications
What are the Listgarden’s 4 zones for NUG
Zone 1: Bacterial zone
- Superficial, contains bacteria
Zone 2: Neutrophil-rich Zone
- Numerous leukocytes, mostly PMN’s, bacteria, spirochetes
Zone 3: Necrotic Zone
- Dead cells, fibers, spirochetes, and other bacteria
Zone 4: Zone of spirochetal infiltration
- Well-preserved tissue infiltrated with spirochetes
What is NUP
Essentially that same as NUG, however there is bone loss involved in NUP
In what people can Primary herpes occur
In kids & Immunocompromised adults
- All races equally, both sexes
In what tissue does primary herpes occur?
Bound & Unbound tissue
Describe the 4 phases of clinical features of Herpes
Prodromal phase
Active phase
Latency
Reactivation
Describe the clinical features of the prodromal phase of herpes
Fever
Irritability
Headache
Gingival Inflammation
Describe the clinical features of the active phase of herpes
Vesicles rupture, yellow ulcers, red halo
Viral shedding (Ave. 12 days)
Mobile and Attached tissue
Heal in 7-14 days with no scarring
Describe the clinical features of the latency phase of herpes
Virus resides in ganglia
Non-replicating state
Latency associated transcripts (LAT)
Describe the clinical features of the reactivation of herpes
Recurrent herpetic stomatitis Spontaneous or stimuli related Virus migrates Herpes labialis (extra-oral) Bound down tissue - Attached gingiva (Intra-oral) Virus overwhelms local immune response
What 4 things may be involved in virus activation
Sunlight
Trauma
Fever
Stress
Describe herpetic whitlow
Recurrent infection
Fingers and hands
Latent site - dorsal root ganglion
Debilitating
T or F, Primary Herpetic Gingivostomatitis is contagious
True
Diagnosis of herpes includes
History and clinical findings
Tzanck smear
Serum antibody titer
ELISA or PCR
T or F, If young adults contract primary herpes it is less severe than if they were children
False, More severe
Treatment of primary herpes
Supportive treatment - Bed rest, bland mouthwashes (alcohol free) - Force fluids, Antipyretics - Lidocaine gel, CHX Systemic medication - Valcyclovir, Vibaradine, Acyclovir
Describe the periodontium in children or deciduous dentition
Pale pink
Firm
Either smooth or stippled (stippled in 35% of children between ages of 5-13)
Interdental gingiva is broad facio-lingually, and narrow mesiodistally
Mean gingival sulcus depth in deciduous dentition
1mm
Is PDL of deciduous teeth more narrow or wider than permanent teeth
Wider than that of permanent teeth
Describe the trabeculae in alveolar bone of deciduous dentition
Trabeculae in alveolar bone are fewer but thicker than in the adult
Crests of interdental bony septa of deciduous dentition compared to permanent dentition
Deciduous dentition are flat
Chronic Marginal Gingivitis (deciduous dentition)
Most prevalent disease of childhood Looks like chronic gingivitis BOP and pocketing is less common Plaque etiology (less than in adults) - Calculus (4-6, 9%; 7-9, 18%; 10-15, 33-43%)
Malpositioned teeth in deciduous dentition:
Accumulate more plaque Increased gingivitis - excessive overbite - excessive overjet - nasal obstruction - mouthbreathing
Diseases altering oral mucosa including the gingiva in deciduous dentition
Varicella
Rubeola (measles)
Scarlatina (scarlet fever)
Diphtheria
Describe the pre-eruption bulge
Before crown appears in oral cavity, the gingiva presents a bulge that is firm, slightly blanched and conforms to the shape of the underlying crown
T or F, during mixed dentition, it is normal for the marginal gingiva around the permanent teeth to be very prominent, especially in the maxillary anterior region
True
Suprabony pocket vs Intra/Infrabony pocket
Suprabony
- Base of pocket is coronal to level of underlying bone
- Horizontal bone loss
- Transseptal CT fibers are horizontal
Infra/Intrabony
- Base of pocket is apical to the level of the adjacent bone
- Vertical bone loss
- Transseptal CT fibers run length of defect vertically (obliquely)
Why do we do pocket reduction therapy?
- Rationale for pocket reduction is based on the need to eliminate areas of plaque accumulation
- Pockets create area where daily plaque removal becomes impossible
Define Periodontal abscess
Acute localized accumulation of viable and nonviable PMNs within the pocket wall
Define Gingival Abscess
Acute localized purulent infection that involves the marginal gingiva and interdental papilla due to bacteria carried into gingival tissue
Etiology or causes of Periodontal abscess
Extension from infected pocket: G- MO
Incomplete removal of calculus
Root fracture
Multiple abscesses
Clinical features of periodontal abscess
Localized purulent inflammation in periodontal tissues
Dull, constant pain, recent origin
Edematous, erythematous, smooth, shiny surface
Mobility
Rapid pocket formation
Discharge of pus with probe or pressure
Fenestrations vs Dehiscence
Fenestrations: Window in bone on facial or lingual
Dehiscence: Loss of alveolar bone on the facial (rarely lingual) aspect of a toothat that leaves a characteristic oval, root-exposed defect from the cementoenamel junction apically
Normal bone morphology
- Crest follows the CEJ and is 1-2 mm apical
- Interproximal higher (more coronal) than facial and lingual
- Scalloped
- Usually thicker facial alveolar bone than lingual alveolar bone
