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Perio 1 > Necrotizing Perio Disease > Flashcards

Necrotizing Perio Disease Flashcards

1
Q

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

A

Necrotizing periodontal disease

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2
Q

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

A

Necrotizing periodontal disease

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3
Q

What are the 3 forms of necrotizing periodontal diseases?

A

Necrotizing gingivitis
Necrotizing periodontitis
Necrotizing stomatitis

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4
Q

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

A

HIV-infected individuals

Malnourished children

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5
Q

What is the most important bacteria in necrotizing periodontal disease?

A

Spirochetes then fusobacterium

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6
Q 
\_\_\_\_\_\_ 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
A

Microbiological; necrotizing periodontal disease

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7
Q

______ risk factors of _____ disease
PMN function
Immune system

A

Host immune responses; necrotizing periodontal disease

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8
Q 
\_\_\_\_\_\_ 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
A

Predisposing; nectorizing perio disease

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9
Q

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

A

Increase cortisol

Decreases immune system

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10
Q
  • 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
A

HIV pt

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11
Q

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

A

<500

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12
Q

What ANC count requires abx prophy?

A

<500 ANC

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13
Q

What platelet count requires platelet transfusion b4 tx?

A

<50,000

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14
Q

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
A

HIV/AIDS pt

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15
Q

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

A

necrotizing gingivitis

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16
Q

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

A

Necrotizing periodontitis

17
Q 
Affects Surface epithelium in nec periodontitis:
It is destroyed and replaced 
by a meshwork of fibrin, 
necrotic epithelium, PMNs 
and various types of 
microorganism.
A

Pseudomembrane

18
Q

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

A

Linear erythema

19
Q

____ signs of NPD
Gingival necrosis
Gingival bleeding
Pain

A

Primary signs and symptoms

20
Q 
Other common s&s of \_\_\_
Pseudomembrane
Halitosis
Adenopathies
Fever
A

NPD

21
Q

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
A

NPD

22
Q
  • 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)
A

Necrotizing gingivitis

23
Q 
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%)
A

Necrotizing gingivitis

24
Q

What 4 bacteria are present in nec gingivitis?

A

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

25
Q

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)

A

Linear gingival erythema

26
Q

How do you tx nec gingivitis?

A

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

27
Q 
- 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
A

Necrotizing periodontitis

28
Q

_____ 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

A

NP

29
Q 
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
A

Necrotizing perio

30
Q

What is the most common microorg in NP besides spriochetes?

A

Candida albicans

31
Q

How do you treat necrotizing periodontitis?

A

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

32
Q

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

A

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

33
Q

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

A

C. When Absolute Neutrophil Count is less than 500

34
Q 
- 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
A

Necrotizing stomatitis

35
Q 
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
A

Necrotizing stomatitis

36
Q

How do you treat necrotizing stomatitis?

A

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

37
Q

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

A

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

Perio 1 (12 decks)

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