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lecture 6 (E2) Flashcards

1
Q

describe the clinical presentation of necrotizing peridontal ds

A
  • sudden onset and it can become a “chronic condition”
  • characterized by gingival tissue necrosis and ulceration
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2
Q

the three forms of periodontal ds

A

necrotizing gingivitis

necrotizing periodontitis

necrotizing stomatitis

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3
Q

target poppulation for necrotizing periodontal ds is

A
  • HIV infected individuals
  • Malnourished children
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4
Q

etiology and risk factors for necrotizing periodontal ds - microbiology

A

1 spirochetes and fusiform bacteria

specific features in HIV. Especially if not well controlled, immune system super weak.

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5
Q

pre-disposing factors for necrotizing peridontal ds

A
  • pre-existing systemic ds HIV/AIDS
  • inadequate oral hygiene high risk to getting the bacteria.
  • Malnutrition
  • Stress
  • smoking/alcohol smoking creates a favorable environment.
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6
Q

mechanism on how stress can cause necrotizing gingivitis

A
  • increase serum cortisol increase of endogenous corticosteroids.
  • immune system depression more favorable for bacteria.
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7
Q

what is the CD4 count in a pt with HIV/AIDS

A

significant changes occur: <200 clles/mm3 **dn treat

infection occurs frequently HIV+ becomes AIDS: 200-500 cells/mm3

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8
Q

important lab data to monitor what do these mean:

viral count

absolute neutrophil count

platelet count

A

viral count: monitor status of ds, prognosis

absolute neutrophil count: needs ab prophylaxis when ANC <500

platelet count: No procedures if bellow 50,000 (normal: 150,000-450,000)

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9
Q

candidiasis, viral lesions, major apthous ulcers, necrotizing gingivitis, linear gingival erythema, necortizing periodontitis, neoplasma

oral lesions of what

A

HIV/AIDS

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10
Q

how does necrotizing periodontitis lesion look like under light microscopy?

A

identical to a necrotizing gingivitis lesion EXCEPT the destruction of the underlying periodontium.

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11
Q

under light microscopy what does the psuedomembrane look like

A

destroyed, replaced with fibrin, necrotic epithelium, PMNs and various types of microorganism

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12
Q

what does the linear erythema look like under light microscopy?

A

hyperemic with numerous engorged capillaries and dense infiltration of PMNs

body is trying to bring more WBC to fight it off, why it looks red and swollen.

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13
Q

primary S & S of NPD

and other S&S

A
  • gingival nerosis
  • gingival bleeding NOT active bleeding
  • pain

common S&S

  • pseudomembrane
  • halitosis
  • adenopathies
  • fever
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14
Q

what are 4 dx of necrotizing periodontal ds

A

NG necrotizing gingivitis

NP necrotizing periodontitis

NS necrotizing stomatitis

Noma cancrum oris

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15
Q
A

clinical S&S:

- necrosis and ulcer in the interdental papilla

  • gingival bleeding
  • pain
  • pseudomembrane formation
  • halitosis
  • adenopathy
  • fever
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16
Q

clinical characteristics of NG

A

clinical characterisics:

  • not contagious
  • age onset of 15-30 yo
  • strong relationship between onset of ds and stress/anxiety
  • responds to ab and non-sx periodontal therapy
  • 75% pts exhibit a localized defect in neutrophil chemotaxis and/or phagocytosis
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17
Q
A

clinical S&S:

- necrosis and ulcer in the interdental papilla

- gingival bleeding

  • pain
  • pseudomembrane formation
  • halitosis
  • adenopathy
  • fever (less than half % of the time)
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18
Q

microbio of NG

A

fusobacterium nucleatum

spirochetes

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19
Q
A

clinical S&S of NG:

- necrosis and ulcer in the interdental papilla

- gingival bleeding

  • pain
  • pseudomembrane formation
  • halitosis
  • adenopathy
  • fever
20
Q

NG differential dx (7)

A
  1. gingivitis
  2. herpetic gingivostomatitis
  3. linear gingival erythema
  4. mild or grade A/B periodontitis
  5. mucous membrane pemphigoid
  6. allergic rx (nickel)
    1. facticial injury
21
Q
  1. gingivitis
  2. herpetic gingivostomatitis
  3. linear gingival erythema
  4. mild or grade A/B periodontitis
  5. mucous membrane pemphigoid
  6. allergic rx (nickel)
  7. facticial injury
A
  1. gingivitis has poor oral hygiene, gingiva red and inflammed at gingival margins
  2. herpetic gingivostomatitis, a viral infection with gingival erythema around the tooth
  3. linear gingival erythema has a really clear line around the teeth type of presentation that looks realted to HIV pt
  4. mild or grade A/B periodontitis, begins to have bone loss
  5. Mucous membrane pemphigoid more like erythematous blisters
  6. allergic reaction to nickle, just erythemous on the gingiva
  7. facticial injury can still see the interdental papilla

for NG you really see the necrotic interdental papilla as a clinical presentation.

22
Q

how to differentiate NG and Herpetic gingivostomatitis?

A

age, body temp, lesion site, and clinical symptoms

age- NG: 15-30 yrs vs PHG: children

lesion site- NG: interdental papilla vs PHG: gingiva and entire oral mucosa

symptoms- NG: ulcerations, necrotic tissue and a yellowish-white plaque vs PHG: multiple vesicles, disrupt, leave small round fibrin-covered ulcerations.

23
Q

how to differentiate between NG and HIV Association

A

HIV: has an intense linear gingival erythematous marginal gingvitis. May have profuse BOP.

24
Q

NG tx

A
  • improve OH an debridement (SRP)
  • 0.12% chlorohexidine pre and post tx rinse
  • Ab: metronidazole or amoxicillin
25
Necrotizing periodontitis and AIDS
- seen in conjuction with opportunisitic infections. 20% ds incidence of AIDS cases. Seen when CD4 below 200 - NP is used as a market for immune deterioration and a predictor for dx of AIDS since it is seen once CD4 drops below 200.
26
NP S&S
- appearance of NG superimposed over rapid/progressive attachment and bone loss - necrosis of marginal and papillary gingiva - persistent throbbing pain - tooth mobility - lymphadenopathy and low-grade fever
27
Necrotizing periodontitis **- appearance of NG superimposed over rapid/progressive attachment and bone loss** **- necrosis of marginal and papillary gingiva** - persistent throbbing pain - tooth mobility - lymphadenopathy and low-grade fever
28
microbio for NP
70% candida albicans 67% prevotella intermedia spirocetes too
29
4 diff dx of NP:
1. severe or grade C periodontitis 2. ONJ but it shows bone exposure and bone destruction 3. uncontrolled/undiagnozed diabetes 4. severe immune suppresion chemotherapy or leukemia
30
tx of NP
before anything: consult PCP to prevent drug interaction non sx therapy = 0.12% cholorhexidine pre/post tx rinse and debridement with hand instruments ab: meetronidazole and antifungal therapy sx correction may be indicated
31
clinical characteristics NS
- Necrotizing stomatitis - an extension of infection of NP, involves more area of the bone (interradicular, interseptal, and crestal bone) - occurs with other opportunistic infections - seen in less than 5% of AIDS cases - seen when CD4 count is below 50 cells/mm3 - seen as NP but with exposed necrotic alveolar bone
32
NS can also be considered as
localized severe osteomyelitis
33
clinical S&S of NS
- necrosis and ulceration of the gingiva extending into the alveolar mucosa **rapidly** - **exposure of necrotic bone** with extension into osteomyelitis - tooth mobility - lymphadenopathy and fever - bacteremia, septicemia
34
Necrotizing Stomatitis - necrosis and ulceration of the gingiva extending into the alveolar mucosa rapidly - exposure of necrotic bone with extension into osteomyelitis - tooth mobility - lymphadenopathy and fever - bacteremia, septicemia
35
Necrotizing Stomatitis - necrosis and ulceration of the gingiva extending into the alveolar mucosa rapidly - exposure of necrotic bone with extension into osteomyelitis - tooth mobility - lymphadenopathy and fever - bacteremia, septicemia
36
Necrotizing Stomatitis - necrosis and ulceration of the gingiva extending into the alveolar mucosa rapidly - exposure of necrotic bone with extension into osteomyelitis - tooth mobility - lymphadenopathy and fever - bacteremia, septicemia
37
Necrotizing Stomatitis - necrosis and ulceration of the gingiva extending in the alveolar mucosa rapidly - exposure of necrotic bone with extension into osteomyelitis - tooth mobility - lymphadenopathy and fever - bacteremia, speticemia
38
microbio of NS
candida albicans mixed _gram neg ANAerobic infection_ miscellaneous enteric bacteria
39
differential diagnosis of NS
- severe or grade C periodontitis - osteomyelitis (IV vancomycin tx) - uncontrolled/undx diabetes - severe immune suppresion chemotherapy or leukemia
40
tx of NS
- consult PCP to prevent drug interactions - non-sx therapy: 0.12% chlorhexidine pre/post-tx rinse. Debridement to remove oral necrotized tissue. Scaling with hand instruments - Ab: Metronidazole - Sx correction too
41
what is cancrum oris (noma)
- a rapidly progressive often gangrenous infection from the mouth to the face - affect impoverished and malnourished children (2-6 years old) - mostly seen in the poorest countries of Africa, Asia and SA
42
Cancrum Oris (noma) ## Footnote - a rapidly progressive often gangrenous infection from the mouth to the face - affect impoverished and malnourished children (2-6 years old) - mostly seen in the poorest countries of Africa, Asia and SA
43
44
what is this and why
**- necrotizing gingivitis** **- necrosis in the interdental papilla** **- gingival bleeding** - pain - pseudomembrane formation - halitosis - adenopathy - fever
45
**- necrotizing gingivitis** **- necrosis in the interdental papilla** **- gingival bleeding** - pain - pseudomembrane formation - halitosis - adenopathy - fever
46
what is it and why
necrotizing periodontitis **- see NG superimposed over rapid/progressive attachment and BL** **- necrosis of marginal and papillary gingiva** - persistent throbbing pain **- tooth mobility** - lymphadenopathy and low-grade fever
47
what is this and why
**necrotizing periodontitis** **- see NG superimposed over rapid/progressive attachment and BL** **- necrosis of marginal and papillary gingiva** - persistent throbbing pain - tooth mobility - lymphadenopathy and low-grade fever

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