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PERIO I > necrotizing perio dx > Flashcards

necrotizing perio dx Flashcards

1
Q

necrotizing perio dx characterized by:

A

necrosis and
ulceration

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2
Q

necrotizing perio dx onset and duration

A

Sudden onset
and it can become a
“chronic condition”

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3
Q

necrotizing perio dx defined

A

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

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4
Q

nomenclature of necrotizing perio dx over time

A
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5
Q

1989 classification of necrotizning perio dx: stages 1-7

A

staged

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6
Q

1999 classification of necro perio dx

A

4 forms

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7
Q

2017 classification

A
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8
Q

Prevalence/Incidence of necrotizing perio dx in general pop

A

0.5 - 3.3% in general populations

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9
Q

Prevalence/Incidence of necrotizing perio dx in military

A

0.2 - 6.2% in military personnel
* 4%-20.6% when it was close to the end of WW2

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10
Q

Prevalence/Incidence of necrotizing perio dx in students

A

0.9 - 6.7% in students

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11
Q

Prevalence/Incidence of necrotizing perio dx in HIV/AIDS

A

0 - 30 % in HIV/AIDS patients
* 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)

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12
Q

highest prevalence populations for necrotizing perio dx

A

HIV-infected individuals
Malnourished children

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13
Q

etiology/risk factors of necrotizing perio dx: microbial factors

A

Spirochetes and fusiform bacteria
P. intermedia
Treponema
Selenomonas
Fusobacterium species

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14
Q

specific microbio risk factors of HIV pts

A

Candida albicans
Herpes viruses
Superinfecting bacterial species

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15
Q

host determinant risk factors of necrotizing perio dx

A

Systemic modifying factors
PMN function
Pre-exsisting systemic disease
- Leukemia
- Leukopenia
- HIV/AIDS
Previous history of NPD
Pre‐existing gingivitis
Young age and ethnicity

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16
Q

environmental risk factors of necro perio dx

A

Mulnutrition
Stress
Insufficient sleep
Smoking/alcohol consumption
Inadequate oral hygiene

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17
Q

stress effects for necro perio

A
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18
Q

HIV/AIDS

A
  • HIV: Human Immunodeficiency Virus
  • AIDS: Late stage of the HIV infection
  • Marked shift of CD4/CD8 ratio
  • normal ratio is 2:1
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19
Q

AIDS

defined? susceptiable to?

A

Late stage of the HIV infection
* Definition (one of the following)
* CD4 count <200 cells/mm3 in an HIV+ patient
* HIV+ patients with ≥ one opportunistic infection
* - Pulmonary TB
* - Recurrent pneumonia
* - Invasive cervical carcinoma

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20
Q

HIV/AIDS severity based on?

A

Disease severity based on CD4 counts (T-helper cell)

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21
Q

oppurtunistic infections and t cell count of AIDS/HIV
400-500
301-400
201-300
101-200
0-100

A

r

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22
Q

important lab data of necro perio

interpreatation of these?

A
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23
Q

HIV/AIDS
Oral lesions

A
  • Candidiasis
  • Viral lesions
  • Major aphthous ulcers
  • Necrotizing gingivitis
  • Linear gingival erythema
  • Necrotizing periodontitis
  • Neoplasms: Oral hairy leukoplakia, Kaposi’s sarcoma, Non-Hodgkins lymphoma
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24
Q

When to premeditate
HIV/AIDS patients for
invasive procedures?

A

When Absolute Neutrophil Count is less than 500

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25
Q

Necrotizing Gingivitis histopathology

A

It shows nonspecific acute inflammatory reaction surrounding an ulcer within the stratified squamous epithelium and the gingival connective tissue

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26
Q

Necrotizing Periodontitis light microscopy

A

Identical to a necrotizing gingivitis lesion
Except the destruction of the underlying periodontium

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27
Q

light microscopy clinical features observed

A

Pseudomembrane and linear erythema

28
Q

pseudomembrane location and microscopic appearence

A

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

29
Q

linear erythema location and microscopic observations

A

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

30
Q

Electron Microscopy: microscopic zones

A
31
Q

what is seen in this electromicroscopy

A

Bacterial smear
* Spirochetes
* Rods

32
Q

phago in electronmicroscopy

A
  • Neutrophil approach the bacterial zone
33
Q

steps to managing necro perio

A

Assessment
Diagnosis
Treatment

34
Q

assessing necro perio
* Find out?
* Clinical findings account for?
*atypical presentation or non-responding cases?

A
  • Find out predisposing factors
  • Clinical findings account for diagnosis of NPD
  • Microbiological or biopsy assessment in atypical presentation or non-responding cases
35
Q

assessing: possible signs and symptoms of necro perio

primary vs other

A
36
Q

Signs and Symptoms necro perio dx’s
* Necrosis where?
* Bleeding?
* pain?
* Pseudomembrane?
* breath?
* tissue destruction/bone loss?
* gingival recession?
* sensitivity?
* Suppuration?
* Dysgeusia?
* fever?
* Lymph nodes?

A
  • 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
37
Q

Possible Necrotizing Periodontal Diseases

A
38
Q

Possible Necrotizing Periodontal Diseases

A
39
Q

Necrotizing Gingivitis Clinical Characteristics
* Contagious?
* Age onset?
* Strong relationship between?

A
  • Not Contagious
  • Age onset is generally 15-30 years old
  • Strong relationship between onset of disease and level of stress/anxiety
40
Q

Necrotizing Gingivitis Clinical Characteristics
* Respond to what tx?
* 75% patients exhibit localized defects with what immune processes?

A
  • Respond to antibiotic and non-surgical periodontal therapy
  • 75% patients exhibit a localized defect in neutrophil chemotaxis and/or phagocytosis
41
Q

Necrotizing Gingivitis Clinical Symptoms & Signs

A
  • 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%)
42
Q

Necrotizing Gingivitis: Differential Diagnosis possible

A
  • Gingivitis
  • Herpetic gingivostomatitis
  • Mild or grade A/B periodontitis
  • Facticial injury
  • Allergic reaction(Nickel)
  • MMP
  • Linear gingival erythema
43
Q

Differential Diagnosis:
Herpetic Gingivostomatitis

keys to differentiate

A
  • Primary herpetic gingivostomatitis (PHG) is frequently
    mistaken for NPD. (Klotz 1973)
  • Keys to differentiate: Age, body temperature, lesion
    site, clinical symptoms
44
Q

NPD vs PHG

A
45
Q

Differential Diagnosis: necrotizing gingivits vs
HIV association

A

HIV with: Linear gingival erythema, Intense erythematous marginal gingivitis May have profuse BOP

46
Q

Linear gingival erythema with HIV
* Prior to?
* Incidence rate?
* Seen when CD4 count is?

A
  • Prior to other opportunistic infections
  • Incidence of about 30-40% of AIDS cases
  • Seen when CD4 count > 200 cell/mm3
47
Q

Necrotizing Gingivitis non-surgical Treatment

A
  • Improve oral hygiene and debridement
  • 0.12% Chlorhexidine pre/post-treatment rinse
48
Q

Necrotizing Gingivitis Abx Treatment

A
  • Metronidazole 250 mg 3x daily for 7 days (first choice)
  • Or Amoxicillin, 500 mg 3x daily for 7 days
49
Q

Necrotizing Periodontitis Clinical Characteristics
* Seen in conjunction with?
* Disease incidence in AIDS?
* % may be decreasing with?
* Seen when CD4 count is?

A
  • Seen in conjunction with other opportunistic infections
  • Disease incidence of about 20% AIDS cases
  • % may be decreasing with ART medications
  • Seen when CD4 count < 200 cells/mm3
50
Q

Necrotizing Periodontitis used as HIV prognostic marker?

A
  • NP 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
  • NP diagnosis to time of death (Glick et al, 1994)
  • 60% within 18 months
  • 73% within 24 months
51
Q

Necrotizing Periodontitis: Clinical Symptoms & Signs
* Appearance of?
* Necrosis of?
* pain?
* mobility?
* systemic?

A
  • 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
52
Q

Necrotizing Periodontitis: Microbiology

spp

A
  • Candida albicans 70%
  • Prevotella intermedia 67%
  • Campylobacter rectus 47%
  • Actinobacillus actinomyces 28%
  • Porphyromonas gingivalis 23%
  • Miscellaneous enteric bacteria
53
Q

Necrotizing Periodontitis: potential Differential Diagnosis

A
  • Severe or grade C periodontitis
  • Uncontrolled/Undiagnosed diabetes
  • Severe immune suppression: chemotherapy or leukemia
  • ONJ
54
Q

Necrotizing Periodontitis: Treatment, consult?

A

Consult patients’ physician prevent drug interaction

55
Q

Necrotizing Periodontitis non-surgical Treatment

A
  • 0.12% Chlorhexidine pre/post-treatment rinse
  • Debridement with hand instruments
56
Q

Necrotizing Periodontitis: Abx Treatment

A
  • Metronidazole 250 mg 4x daily for 7-10 days
  • Antifungal therapy if indicated
57
Q

Necrotizing Periodontitis Treatment surgery?

A

Surgical correction may be indicated

58
Q

Necrotizing Stomatitis: Clinical Characteristics
* An extension of?
* May be considered?
* Occurs with other?

A
  • 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
59
Q

Necrotizing Stomatitis: Clinical Characteristics with AIDS
* Seen in how many AIDS cases?
* Seen when CD4 count is?
* Seen as?

A
  • Seen in less than 5% of AIDS cases
  • Seen when CD4 count < 50 cells/mm3
  • Seen as NP with areas of exposed necrotic alveolar bone
60
Q

Necrotizing Stomatitis: Clinical Symptoms & Signs
* Necrosis and ulceration?
* Exposure of?
* mobility?
* lymph nodes?
* systemic?

A
  • 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
61
Q

Necrotizing Stomatitis Microbiology

A
  • Candida albicans
  • Mixed gram negative anaerobic infection
  • Miscellaneous enteric bacteria
62
Q

Necrotizing Stomatitis: potential Differential Diagnosis

A
63
Q

Necrotizing Stomatitis Treatment with physician

A

Consult patients’ physicianprevent drug interaction

64
Q

Necrotizing Stomatitis non-surgical Treatment

A
  • 0.12% Chlorhexidine pre/post-treatment rinse
  • Debridement to remove oral necrotized tissue
  • Scaling with hand instruments
65
Q

Necrotizing Stomatitis Abx Treatment

A
  • Metronidazole 250 mg 4x daily for 7-10 days
  • Antifungal therapy if indicated
66
Q

Necrotizing Stomatitis surgical Treatment

A

Surgical correction

67
Q

Cancrum Oris (Noma)
* app/defined?
* demo?
* where?

A
  • A rapidly progressive often gangrenous infection extends from mouth to face
  • Affects impoverished and malnourished children (2-6 years old)
  • In countries in poverty (Africa, Asia, South America)

PERIO I (13 decks)

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