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necrotising diseases Flashcards

1
Q

what are the main clinical signs of necrotising periodontal disease?

A
  • intensely red gingiva
  • spontaneous bleeding
  • extensive necrosis of soft tissues with yellow/white slough
  • punched out papillae
  • pain and odour
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2
Q

what is the aetiology of necrotising periodontal disease?

A
  • systemic immune deficiencies
  • malnutrition
  • stress
  • smoking
  • spirocheats and fusiforms
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3
Q

What is necrotising ulcerative gingivitis?

who is it more common in?

when is it more common

A

an infection characterised by gingival necrosis presenting as ‘punched-out’ papillae, with gingival bleeding and pain

more common in caucasians

male=female

more common during autumn and winter months

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4
Q

what are the predisposing factors of necrotising ulcerative gingivitis

A
  • poor oral hygiene and pre-existing gingivitis
  • emotional stress
  • cigarette smoking
  • poor nutrition/malnutrition
  • immunosuppresion
    *
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5
Q

what is the aetiology of necrotising ulcerative gingivitis?

A
  • an opportunistic infection by anaerobic commensal bacteria
  • spirochaetes & fusiform bacilli = fusospirochaetal complex
  • bacteria invade into the gingival tissues
  • exact trigger not fully known
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6
Q

what are the symptoms of necrotising ulcerative gingivitis?

A
  • sudden onset of painful gingivae
  • gingival bleeding
  • metallic taste
  • halitosis
  • malaise possible
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7
Q

what are the signs of necrotising ulcerative gingivitis?

A
  • erythematous marginal gingivae
  • may be localised or generalised
  • lower anterior region - common site
  • necrotic ulceration - yellow / grey slough
  • necrosis affects interdental papillae, may extend along marginal gingiva
    • punched out interdental papillae
  • raw, bleeding mucosa beneath
  • painful to prove and BOP
  • lymphadenopathy may be present
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8
Q

immediate management of necrotising ulcerative gingivitis

definitive management of necrotising ulcerative gingivitis

A

immediate management of necrotising ulcerative gingivitis

  • aims to relieve pain

definitive management of necrotising ulcerative gingivitis

  • aims to address cause and prevent recurrence
    • debridement of the effected marginal gingivae is essential
    • LA advisable
    • use ultrasonic to remove necrotic slough
    • OHI
      • soft tooth brush should be used
      • hydrogen peroxide mouthwash
    • antibiotics
      • metronidazole 400mg TDS for 3 days commonly prescribed
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9
Q

longer term management of necrotising ulcerative gingivitis

after acute symptoms have resolved

A
  • improve existing OH
  • appropriate ID aids
  • meticulous sub and supra gingival scaling
  • remove PRFs
  • smoking cessation advice
  • (perio surgery to improve gingival contour)
  • be suspicious of an underlying systemic disorder of the immune system
  • patients with unexplained recurrences should be assessed with blood tests
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10
Q

what is necrotising ulcerative periodontitis?

A

an infection characterised by necrosis of gingival tissues, PDL and alveolar bone

NUG may develop into NUP if not treated adequately

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11
Q

what are the predisposing factors of NUP

A

same as NUG

  • poor oral hygiene and pre-existing gingivitis
  • emotional stress
  • cigarette smoking
  • poor nutrition/malnutrition
  • immunosuppresion
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12
Q

what is the aetiology of necrotising ulcerative periodontitis

A

same as NUG

  • an opportunistic infection by anaerobic commensal bacteria
  • spirochaetes & fusiform bacilli = fusospirochaetal complex
  • bacteria invade into the gingival tissues
  • exact trigger not fully known
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13
Q

what are the symptoms of necrotising ulcerative periodontitis?

A
  • sudden onset of painful gingivae
  • gingival bleeding
  • metallic taste
  • halitosis
  • malaise possible
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14
Q

what are the signs of NUP

A
  • same as NUG
    • erythematous marginal gingivae
    • may be localised or generalised
    • lower anterior region - common site
    • necrotic ulceration - yellow / grey slough
    • necrosis affects interdental papillae, may extend along marginal gingiva
    • punched out interdental papillae
    • raw, bleeding mucosa beneath
    • painful to prove and BOP
    • lymphadenopathy may be present
  • also :
    • severe deep aching pain
    • very rapid rate of bone destruction
    • deep pocket formation not evident immediately
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15
Q

what is the management of necrotising ulcerative periodontitis?

A
  • local debridement
    • most cases adequately treated by debridement
  • anaesthetics as needed
  • OHI
  • oral rinses
    • chlorhexidine gluconate
    • hydrogen peroxide/water
  • pain control
  • antibiotics
    • metronidazole
  • modify predisposing factors
    • smoking
    • stress
  • follow up
    • frequent until resolution of symptoms
  • comprehensive periodontal evaluation following acute phase
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16
Q

what is NOMA - Cancrum Oris

A

a disfiguring condition that may follow NUP in developing parts of the world

extensive necrosis and destruction of facial tissue - beyond the alveolar process

linked to severe malnourishment

z restorative (5 decks)

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