necrotising perio Flashcards
What is necrotising periodontal disease and what is it caused by
The most severe inflammatory periodontal disorder caused by plaque bacteria
What are the main features of NPD
painful, bleeding gums and ulceration and necrosis of the interdental papilla - punched-out appearance
What are the classifications of necrotizing perio diseases
Necrotizing gingivitis
Necrotizing periodontitis
Necrotizing stomatitis
What is Necrotizing gingivitis
when only the gingival tissues are affected
What is necrotizing periodontitis
when the necrosis progresses into the periodontal ligament and the alveolar bone, leading to attachment loss
What is necrotizing stomatitis and what may it lead to
when the necrosis progresses to deeper tissues beyond the mucogingival line, including the lip or cheek mucosa, the ton- gue, etc
may result in denudation of the bone leading to osteitis and oro-antral fistulas
What is cancrum oris
(also termed noma) is a necrotizing and destructive infection of the mouth and face, and therefore not strictly speaking a periodontal disease
What is a diagnosis of NPD based on
Symptoms
What are the symptoms of NPD
Ulcerated and necrotic papillae and gingival margin resulting in a characteristic punched-out appearance
The ulcers are covered by a yellowish, white or greyish slaim, no coherence only slime made of fibrin, necrotic tissue, leucocytes, erythrocytes and mass of bacteria. When this ‘membrane’ is removed, the underlying connective tissue becomes exposed and bleeds.
Lesions develop quickly
Lesions are very painful – severe pain
Bleeding readily provoked
The first lesions are most often seen interproximally in the mandibular anterior region
Foetor ex ore
What is meant by Foetor ex ore
bad breathe
What is the ulcerations often associated with in NPD
deep pockets formation as gingival necrosis coincides with loss of crestal alveolar bone
Ulcers with central necrosis develop into craters
What is found in most severe cases
adenopathies
If present, submandibular lymph nodes are more affected than those in the cervical area
Why is diagnosis of NPD not based on any test
Biopsy – histopathology is not pathognomic (characteristic) for NPD
Microbiology – not characteristic as well
What is it important to differentiate NPD from
Oral mucositis
HIV-associate periodontitis
Herpes simplex virus (HSV)
Scurvy
Gingivostomatitis
Desquamative gingivitis
Invasive fungal disease
Illicit-drug related gingival disease
Agranulocytosis
Leukemia
Chronic periodontitis
In developed countries NPD occurs mostly in what group and what are the predisposing factors
Young adults
stress, sleep deprivation, poor oral hygiene, smoking, immunosuppression (HIV infection and leukaemia) and/or malnutrition
In developing countries NPD mostly occurs in what group
malnourished children
What are the objectives of the acute phase treatment of NPD
1) to arrest the disease process and tissue destruction;
2) to control the patient′s general feeling of discomfort and pain that is interfering with nutrition and oral hygiene practices
What is carried out in the acute phase of treatment
The first task should be a careful superficial debridement to remove the soft and mineralized deposits. Exerting minimal pressure over the ulcerated soft tissues
The debridement should be performed daily and lasting for as long as the acute phase lasts (normally 2 –4 days)
What should be limited during treatment and what should replace it
Mechanical oral hygiene measures should be limited because brushing directly in the wounds may impair healing and induce pain.
During this period the patient is advised to use chemical plaque control formulations, such as chlorhexidine-based mouthrinses (0.12–0.2%, twice daily)
Other products have also been suggested, such as 3% hydrogen peroxide diluted 1:1 in warm water
When would antibiotics be used
In cases that show unsatisfactory response to debridement or show systemic effects (fever and/or malaise)
What antibiotics would you use and how much and long for
Metronidazole 400mg 1 tablet three times daily for 3 days
How often should you see patients with NPD
Patients have to be followed up very closely (daily, if possible) and as the symptoms and signs improve, strict mechanical hygiene measures should be enforced, as well as complete debridement of the lesions
Once the acute phase has been treated what do you do
Treatment of the pre-existing condition
NPD normally occurs over a pre-exsisting condition (chronic gingivitis , periodontitis) so once the acute phase is finished carry out professional prophylaxis and/or PMPR
OHI and motivation should be reinforced and predisposing local factors (overhanging restorations, interdental open spaces and tooth malposition) evaluated and treated
After acute phase and pre-existing condition have been reated what would be considered next and why and how
Corrective phase treatment
As the disease may leave behind altered gingival topography (e.g. gingival craters) These should be treated as they may favour plaque accumulation and disease recurrence
This would be done by Gingivectomy and/or gingivoplasty procedures (periodontal flap surgery, or even regenerative surgery, are more suitable options for deep craters)
After the corrective phase treatment what is next
Supportive or maintenance phase
Main goal is compliance with the oral hygiene practises and control of predisposing factors
