Necrotizing Perio Disease Flashcards by Michael McMahan

Clinical presentation of _______:
Characterized by gingival tissue necrosis and ulceration
-Sudden onset and it can become a
“chronic condition”

Necrotizing periodontal disease

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A rare and destructive form of
periodontal disease caused by
microorganism in the context
of an impaired host response

Necrotizing periodontal disease

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What are the 3 forms of necrotizing periodontal diseases?

Necrotizing gingivitis
Necrotizing periodontitis
Necrotizing stomatitis

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What are the 2 groups of pts that are more likely to get necrotizing periodontal disease?

HIV-infected individuals

Malnourished children

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What is the most important bacteria in necrotizing periodontal disease?

Spirochetes then fusobacterium

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\_\_\_\_\_\_ risk factors of \_\_\_\_\_ disease
Spirochetes and fusiform bacteria
P. intermedia
Treponema
Selenomonas
Fusobacterium species
Specific features in HIV
Candida albicans 
Herpes viruses 
Superinfecting bacterial species

Microbiological; necrotizing periodontal disease

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______ risk factors of _____ disease
PMN function
Immune system

Host immune responses; necrotizing periodontal disease

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\_\_\_\_\_\_ risk factors of \_\_\_\_\_ disease
Pre-exsisting systemic disease
- Leukemia
- Leukopenia
- HIV/AIDS
Previous history of NPD
Pre‐existing gingivitis
Inadequate oral hygiene
Mulnutrition
Stress/Insufficient sleep
Smoking/alcohol consumption
Young age and ethnicity

Predisposing; nectorizing perio disease

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How does stress and anxiety impact cortisol levels and immune system function leading to necrotizing gingivitis?

Increase cortisol

Decreases immune system

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Marked shift of CD4/CD8 ratio (normal 2:1)
Definition (one of the following)
CD4 count <200 cells/mm3 in a patient
patients with ≥ one opportunistic infection
Pulmonary TB
Recurrent pneumonia
Invasive cervical carcinoma

HIV pt

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If an HIV pt has less than _____ CD4 t helper cell ct, turn on your alarm

<500

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What ANC count requires abx prophy?

<500 ANC

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What platelet count requires platelet transfusion b4 tx?

<50,000

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Oral lesions of _______:

Candidiasis
Viral lesions
Major aphthous ulcers
Necrotizing gingivitis
Linear gingival erythema
Necrotizing periodontitis
Neoplasms
Oral hairy leukoplakia
Kaposi’s sarcoma
Non-Hodgkins lymphoma

HIV/AIDS pt

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A ________ lesion shows nonspecific
acute inflammatory reaction surrounding an ulcer
within the stratified squamous epithelium and the
underlying gingival connective tissue

necrotizing gingivitis

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A ________ lesion shows nonspecific
acute inflammatory reaction surrounding an ulcer
within the stratified squamous epithelium and the
underlying gingival connective tissue
-the destruction of the underlying periodontium
-bone destruction

Necrotizing periodontitis

Affects Surface epithelium in nec periodontitis:
It is destroyed and replaced 
by a meshwork of fibrin, 
necrotic epithelium, PMNs 
and various types of 
microorganism.

Pseudomembrane

Affects Underlying connective tissue in nec periodontitis:
It is hyperemic with numerous
engorged capillaries and
dense infiltration of PMNs

Linear erythema

____ signs of NPD
Gingival necrosis
Gingival bleeding
Pain

Primary signs and symptoms

Other common s&s of \_\_\_
Pseudomembrane
Halitosis
Adenopathies
Fever

NPD

The following are signs and symptoms of ______:

Necrosis and ulcer in the interdental papilla
Bleeding spontaneously or while brushing
Mild to moderate pain
Pseudomembrane formation
Halitosis
May have aggressive tissue destruction/bone loss
Severe gingival recession
Hypersensitivity
Suppuration
Dysgeusia
Low-grade fever
Lymphadenopathy

NPD

Not Contagious
Age onset is generally
15-30 years old
Strong relationship
between onset of disease
and level of stress/anxiety
Respond to antibiotic
and non-surgical
periodontal therapy
75% patients exhibit a
localized defect in
neutrophil chemotaxis
and/or phagocytosis
(punched out papilla)

Necrotizing gingivitis

Signs and symps of \_\_\_\_\_\_:
- Necrosis and ulcer in the 
interdental papilla (94–100%) 
- Gingival bleeding (95–100%) 
- Pain (86–100%) 
- Pseudomembrane formation 
(73–88%) 
- Halitosis (84–97%) 
- Adenopathy (44–61%) 
- Fever (20‐39%)

Necrotizing gingivitis

What 4 bacteria are present in nec gingivitis?

Fusobacterium nucleatum
Prevotella intermedia
Treponema spp.
Spirochetes (Selenomonas spp.)

Intense erythematous marginal gingivitis May have profuse BOP - Prior to other opportunistic infections - Incidence of about 30-40% of AIDS cases - Seen when CD4 count is > 200 cell/mm3 - Microbiology: - Fusobacterium nucleatum - Porphyromonas gingivalis - A. actinomycetemcomitans - Treponema spp. - Candidas (evidence showed it may be the primary etiology)

Linear gingival erythema

How do you tx nec gingivitis?

Improve oral hygiene and SRP 0.12% Chlorhexidine pre/post-treatment rinse Antibiotics: Metronidazole 250 mg 3x daily for 7 days (first choice) Or Amoxicillin, 500 mg 3x daily for 7 days

``` - Seen in conjunction with other opportunistic infections - Disease incidence of about 20% of AIDS cases (% may be decreasing with ART medications) - Seen when CD4 count is below 200 cells/mm3 ```

Necrotizing periodontitis

_____ is used as a marker for immune deterioration and a predictor for the diagnosis of AIDS since it appears with CD4 counts below 200 cells/mm3 -Can be used as diagnosis to time of death (Glick et al, 1994) - 60% within 18 months - 73% within 24 months

``` Clinical Signs & Symptoms of ____ - 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 ```

Necrotizing perio

What is the most common microorg in NP besides spriochetes?

Candida albicans

How do you treat necrotizing periodontitis?

0.12% Chlorhexidine pre/post-treatment rinse Debridement with hand instruments Antibiotics: Metronidazole 250 mg 4x daily for 7-10 days Antifungal therapy if indicated Surgical correction may be indicated

Which of the following statement about the oral lesions of HIV/AIDS is correct? A. Necrotizing gingivitis incidence of about 75% of AIDS cases B. Linear gingival erythema is seen when CD4 count is below 200 cell/mm3 and used as a predictor for the diagnosis of AIDS C. Necrotizing periodontitis is seen prior to other opportunistic infections D. Necrotizing periodontitis is seen when CD4 count is below 200 cell/mm3 and used as a predictor for the diagnosis of AIDS

D. Necrotizing periodontitis is seen when CD4 count is below 200 cell/mm3 and used as a predictor for the diagnosis of AIDS

When to premeditate HIV/AIDS patients for invasive procedures? A. When CD4 count is less than 200 cells/mm3 B. When platelet count is less than 50,000 C. When Absolute Neutrophil Count is less than 500 D. When the viral count is less than 500

C. When Absolute Neutrophil Count is less than 500

``` - An extension of the infection of NP to involve interradicular, interseptal and crestal bone - May be considered as a localized severe osteomyelitis - 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 with areas of exposed necrotic alveolar bone ```

Necrotizing stomatitis

``` Clinical Signs & Symptoms of _______ - 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 ```

Necrotizing stomatitis

How do you treat necrotizing stomatitis?

Consult patients’ physician to prevent drug interaction Non-surgical therapy: 0.12% Chlorhexidine pre/post-treatment rinse Debridement to remove oral necrotized tissue Scaling with hand instruments Antibiotics: Metronidazole 250 mg 4x daily for 7-10 days Antifungal therapy if indicated

Please chose the appropriate treatment for necrotizing periodontal disease A. Necrotizing gingivitis does not respond well to non-surgical treatment thus surgical correction is always required B. Necrotizing periodontitis requires non-surgical treatment including debridement and 0.12% Chlorhexidine mouth rinse, then re-evaluation of the indication for surgery C. Amoxicillin is the first choice to prescribe for necrotizing periodontal disease D. Necrotizing stomatitis requires debridement to remove plaque and calculus, and leave the necrotized tissue to serve as the protection membrane

B. Necrotizing periodontitis requires non-surgical treatment including debridement and 0.12% Chlorhexidine mouth rinse, then re-evaluation of the indication for surgery