Necrotizing Periodontal Disease Flashcards
What causes necrotizing periodontal diseases?
Plaque bacteria
What are the characteristics of NPD?
Rapidly destructive and debilitating shared predisposing factors - under stress opportunistic infection
What are the main features of NPD?
Painful, bleeding gums and ulceration and necrosis of interdental papilla - punched out appearance
What is necrotizing gingivitis?
When only gingival tissues infected
What is necrotizing periodontitis?
When necrosis progresses into PDL and alveolar bone leading to attachment loss
What is necrotizing stomatitis?
Necrosis progresses into deeper tissues beyond mucogingival line including lip or cheek mucosa and tongue
Who does necrotizing stomatitis usually occur in?
Malnutrition or HIV infected peopled
What does necrotizing stomatitis result in?
Denudation of bone leading to osteitis and oral antral fistula
What is cancrum oris?
Necrotizing and destructive infection of mouth and face occurring in malnourished children
What is Vincent’s angina?
Necrotising inflamation of the tonsils and pharynx, caused by NUG
What does the gingiva look like in necrotizing gingivitis
Ulcerated and necrotic papillae and gingival margin resulting in a characteristic punched out appearance
What are the ulcers covered with?
Slime made of fibrin, necrotic tissue, leucocytes, erythrocytes and mass of bacteria
What are the symptoms of necrotizing gingivitis?
Ulcerated papilla covered in slime quick developing lesions which are painful bleed if provoked first lesions interproximally in mandibular anterior region
What are the symptoms of necrotizing periodontitis?
Ulcers with deep pockets
Ulcers which develop into craters due to central necrosis
Adenopathy’s in severe cases fever
Feeling of discomfort
Why is diagnosis not based on bacterial tests?
As spirochetes and fusobacterias are not always found in the primary lesion
What are the differential diagnoses for a patient with suspected necrotizing periodontal disease?
Oral mucositis
HIV associated periodontitis
HSV
Scurvy
Gingivostomatitis
Desquamative gingivitis
Invasive fungal disease
Illicit drug related gingival disease
Agranulocytosis
Leukemias
Chronic periodontitis
What is herpetic gingivostomatitis caused by?
HSV
Who does herpetic gingivostomatitis affect?
Children
What area in the mouth does herpetic gingivostomatitis affect?
Gingiva and entire oral mucosa
What is the symptoms of herpetic gingivostomatitis?
Multiple vesicles which disrupt, leaving small round fibrin covered ulcerations
What are the risk factors for NPD?
Stress, sleep deprivation, poor OH, smoking, immunosuppression malnourished children - developing countries
What are the 2 objectives of treatment?
Arrest disease process and tissue destruction control patients general feeling of discomfort and pain interfering with nutrition and OH
What is treatment of NPD?
Superficial debridement to remove deposits daily for as long as acute phase lasts (2-4 days)
What should the patient not do during NPD treatment and what should they do instead?
No mechanical oral hygiene use chlorhexidine mouthwash instead
Why should the patient not use mechanical oral hygiene during NPD treatment?
It can disrupt healing process after debridement
What should you prescribe if patient shows unsatisfactory response to debridement or shows systemic effects?
Metronidazole 400mg three times daily 3 days
Why are locally delivered antimicrobials not recommended in NPD?
Large numbers of bacteria present within tissues where local drug will not be able to achieve adequate concentrations
How often should you be seeing NPD patients?
Every day
What do you do once you have treated the acute phase of the disease?
Treat the pre-existing condition (gingivitis/periodontitis) control systemic predisposing factors
Why should correction of gingival anatomy be considered?
Plaque accumulation can occur in the craters
What are the options for corrective treatment of the disease?
Gingivectomy/gingivoplasty procedures periodontal flap surgery regenerative surgery
What is the goal during supportive or maintenance phases?
Compliance with oral hygiene practices and control of predisposing factors
What should the patient be screened for if they have NPD and why?
HIV as they might not be aware of their condition
