Necrotizing Perio Disease Flashcards
Clinical presentation of _______:
Characterized by gingival tissue necrosis and ulceration
-Sudden onset and it can become a
“chronic condition”
Necrotizing periodontal disease
A rare and destructive form of
periodontal disease caused by
microorganism in the context
of an impaired host response
Necrotizing periodontal disease
What are the 3 forms of necrotizing periodontal diseases?
Necrotizing gingivitis
Necrotizing periodontitis
Necrotizing stomatitis
What are the 2 groups of pts that are more likely to get necrotizing periodontal disease?
HIV-infected individuals
Malnourished children
What is the most important bacteria in necrotizing periodontal disease?
Spirochetes then fusobacterium
\_\_\_\_\_\_ 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
______ risk factors of _____ disease
PMN function
Immune system
Host immune responses; necrotizing periodontal disease
\_\_\_\_\_\_ 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
How does stress and anxiety impact cortisol levels and immune system function leading to necrotizing gingivitis?
Increase cortisol
Decreases immune system
- 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
If an HIV pt has less than _____ CD4 t helper cell ct, turn on your alarm
<500
What ANC count requires abx prophy?
<500 ANC
What platelet count requires platelet transfusion b4 tx?
<50,000
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
A ________ lesion shows nonspecific
acute inflammatory reaction surrounding an ulcer
within the stratified squamous epithelium and the
underlying gingival connective tissue
necrotizing gingivitis
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
NP
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
