Necrotising periodontal diseases

Question 1

Characteristics of necrotising periodontal diseases

Answer 1

most severe inflammatory periodontal disorder caused by plaque bacteria
rapidly destructive and debilitating
opportunistic infection

Question 2

necrotising periodontal diseases - main clinical features

Answer 2

painful, bleeding gums
ulceration and necrosis of the interdental papillae
- punched-out appearance

Question 3

necrotising gingivitis

Answer 3

when only the gingival tissues are affected

Question 4

necrotising periodontitis

Answer 4

when the necrosis progresses into the periodontal ligament and alveolar bone
- leads to attachment loss

Question 5

necrotising stomatitis

Answer 5

when the necrosis progresses into deeper tissues beyond the mucogingival line, including the lip or cheek mucosa, the tongue etc

Question 6

Answer 6

necrotising gingivitis

Question 7

Answer 7

necrotising periodontitis

Question 8

Answer 8

necrotising stomatitis

Question 9

necrotising gingivitis clinical features

Answer 9

ulcerated and necrotic papillae and gingival margin resulting in a characteristic punched-out appearance
ulcers are covered by a yellowish, white or greyish slaim
- when removed, underlying connective tissue becomes exposed and bleeds
lesions develop quickly
severe pain
bleeding readily provoked
first lesions are most often seen interproximally in the mandibular anterior region

Question 10

necrotising periodontitis clinical features

Answer 10

ulcerations are often associated with deep pocket formation as gingival necrosis coincides with loss of crestal alveolar bone
ulcers with central necrosis develop into craters
fever and a general feeling of discomfort rare

Question 11

necrotising stomatitis clinical features

Answer 11

bone loss extends through the alveolar mucosa
larger bone sequestra may occur
- with larger areas of osteitis and oral-astral fistulae
lesions are of greater severity with severe immunocompromised patients
- AIDS and severe malnutrition

Question 12

necrotising periodontal disease - differential diagnoses

Answer 12

oral mucositis
HIV-associated periodontitis
HSV ]
scurvy
gingivostomatitis
dequamative gingivitis
invasive fungal disease
illiciit drug related gingival disease
leukaemia
agranulocytosis
chronic periodontitis

Question 13

Necrotising periodontal disease risk factors

Answer 13

stress
sleep deprivation
poor oral hygiene
smoking
immunosuppression
malnourishment (developing countries)

Question 14

necrotising periodontal disease - aims of acute phase treatment

Answer 14

to arrest the disease progress and tissue destruction
to control patients feeling of discomfort and pain that is interfering with nutrition and oral hygiene practices

Question 15

Necrotising periodontal disease - acute phase treatment

Answer 15

superficial debridement to remove soft and mineralised deposits
- ultrasonic devices recommended = minimal pressure
- perform daily for 2-4 days
advise use of 0.12% chlorhexidine mouthwash twice daily

Question 16

necrotising periodontal disease - treatment following acute phase

Answer 16

treat pre-existing condition
- normally occurs over a pre-existing chronic gingivitis or periodontitis infection
control predisposing factors
- sleep
- smoking
- stress
- vitamin supplements

Question 17

why might gingival surgery be indicated for a patient following resolution of necorotising periodontal disease?

Answer 17

gingival craters way be present
- favours plaque accumulation and disease recurrence