Necrotising Periodontal Diseases Flashcards
Give 3 main features of necrotising periodontal disease (NPD).
- Acute lesion
- Most severe condition associated with dental biofilm
- Rapid tissue destruction.
- Give 4 common patient complaints that come with NPD.
painful gums
bleeding gums
bad breath
unpleasant taste
Give 2 rare patient complaints that come with NPD.
feeling unwell and swollen glands
Give 5 common signs that come with NPD.
Ulceration of the papillae which may extend to marginal gingivae
–Localised – commonly anterior teeth
–Generalised – rarely may affect whole mouth
Necrotic fibrinous slough covering ulcers
Gingivae bleeding after gentle probing
Erythema around margins of lesions
Plaque present +/- plaque retentive factors
Give 2 less common signs that come with NPD.
elevated temperature and lymphadenopathy
What is the prevalence of NPD?
Prevalence/incidence of NG has been reported for the overall population or for specific groups of individuals.
In general populations attending dental clinics, the prevalence of NG ranged from 0.51 to 3.3%.
In military personnel, the prevalence and incidence reported was higher close to the end of the 2nd World War (3.96–20.6%) than it was in more recent studies (0.19–6.19%).
In African populations, highly variable results have been reported.
In students, prevalence ranged from 0.9 to 6.7%.
In HIV/AIDS patients data showed wide variations: -Children (2.2-5.0%)-HIV adults (0.0–27.7% for NG and 0.3–9.0% for NP)-HIV/AIDS patients (10.1–11.1% for NG and 0.3–9.0% for NP).
Give 4 predisposing factors for NPD.
Plaque present
–PD= occurs due to Traditionally poor plaque control & underlying chronic inflammation
–NPD= can occur Moderate plaque control + reduced host response
+/- Calculus or other plaque retentive factors
Microorganisms – Specific species–Fusobacterium nucleatum
–Spirochaetes
– Treponema species
– Other species including Prevotella intermedia & Porphyromonas gingivalis Fuso-spirochaetal complex
Microorganisms in necrotic slough invade tissues and contribute to tissue necrosis
Most relevant predisposing factor is host immune response:
- Acute inflammatory cells (PMNs)
- Plasma cells & lymphocytes
Which bacteria are commonly found in NPD and how do they present?
- Fusobacterium nucleatum and spirochaetes - Treponema species.
- These form a fuso-spirochaetal complex.
Give 2 less commonly found bacteria found in NPD patients.
- Prevotella intermedia
- Porphyromonas gingivalis.
What 4 factors can result in reduced host defence and consequently NPD?
- Smokers – much more common 2. Stress - “trench mouth” & students during exams *
- Immune compromise eg:
– Leukaemia
– HIV infection (particularly if untreated)
– Other viral illness eg. glandular fever & measles - Malnutrition – developing countries
What is a potential aggravation of npd?
Cancrum oris (Noma)
–highly destructive
–infection spreads out from gingivae
–severely immunosuppressed/malnutrition
–rare in the UK but it can happen
How does a patient with HIV and NPD present in comparison to a sole NPD patient?
HIV - more frequent and show faster progression, with a higher risk of evolving into more severe lesions
–may be a first sign of AIDS (necrotising gingivitis)
–poor response to initial treatment
Give 4 features of patients that have HIV and present with NPD.
Necrotising forms of periodontitis (ANUG type periodontitis)
Very rapidly progressing chronic marginal periodontitis –May become chronic
less painful–severe tissue destruction with recession
“Linear” gingivitis described by some but definitely not only HIV patients
– Very erythematous marginal gingiva
What incidences are increase with HIV related NPD?
Increased incidence of malignant lesions involving periodontal tissues (rare) - T-cell lymphoma and Kapsosi’s sarcoma
No HIV-specific periodontal lesion BUT In combination with other oral lesions
–Atrophic candidiasis
–Black hairy tongue
What history is taken for an NPD patient?
medical
socail
smoking
What examination is carried out for an NPD patient?
Sites & extent of disease
Local factors eg. plaque & retentive factors
Other oral disease Lymphadenopathy & pyrexia
How is NPD treated initially (4 steps)?
- Course of metronidazole:
– Except in pregnant women, liver disease or alcoholics
– 400mg tds for 3-5 days - Advice about oral hygiene & smoking cessation:
–Consider use of chlorhexidine mouth rinse short term - Local debridement if comfort allows
Review in one week
– Consider referral, special tests etc. if condition has not started to respond to the above
How is NPD managed long-term?
Treat underlying periodontal disease
Reinforce advice about smoking if necessary
Reinforce advice about nutrition
Consider gingival architecture after acute management
Consider residual chronic inflammatory periodontal disease
Consider surgery to obtain cleansable gingival contour -
Avoiding use of pack
