Necrotizing Periodontal Diseases Flashcards

Question

What are the microscopic zones from tissue surface (superficial) to lamina propria (deep)?

Answer 1

◦ Conventional periodontal pockets with deep probing depths are not found in NUP. ◦ In periodontitis, periodontal pockets are formed because the junctional epithelial cells remain viable and can migrate apically to cover areas of lost connective tissue attachment. ◦ The necrosis of the junctional epithelium in NUG and NUP creates an ulcer that prevents the junctional epithelium migration apically. ◦ A periodontal pocket cannot form due to this.

Answer 2

Primary ◦ Gingival necrosis ◦ Gingival bleeding ◦ Pain Other common signs and symptoms ◦ Pseudomembranes ◦ Halitosis ◦ Lymphadenopathies ◦ Fever ◦ May have aggressive tissue destruction/bone loss ◦ Severe gingival recession ◦ Hypersensitivity ◦ Suppuration ◦ Dysgeusia ◦ Low-grade feve

Answer 3

(Acute) Necrotizing Ulcerative Gingivitis

Answer 4

Necrotizing Ulcerative Periodontitis

Answer 5

Necrotizing Stomatitis

Answer 6

Cancrum Oris

Answer 7

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

Answer 8

◦ Necrosis and ulceration in the interdental papillae (94-100%) ◦ Gingival Bleeding (95-100%) ◦ Pain (86-100%) ◦ Pseudomembrane formation (73-88%) ◦ Halitosis (84-97%) ◦ Adenopathy (44-61%) ◦ Fever (20-39%)

Answer 9

Stress and Disease Onset - Stress/Anxiety/Depression + Negative Life Event - leads to --- Increased Serum Cortisol --- Immune System Depression

Answer 10

◦ Fusobacterium nucleatum ◦ Prevotella intermedia ◦ Treponema spp. ◦ Spirochetes

Answer 11

- Gingivitis - Allergic reaction(Nickel) - Herpetic gingivostomatitis - Mild or grade A/B periodontitis - Mucous membrane pemphigoid - Factitial injury

Answer 12

NPD (nectrotizing periodontal disease) Keys to differentiate: ◦Age ◦Body temperature ◦Lesion site ◦Clinical symptoms

Answer 13

Non-surgical therapy: ◦ Improve oral hygiene ◦ Debridement ◦ 0.12% Chlorhexidine pre/post-treatment rinse Antibiotics: ◦ Metronidazole 250 mg 3X daily for 7 days (first choice) ◦ Amoxicillin 500 mg 3X daily for 7 days

Answer 14

* 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

Answer 15

* 60% within 18 months * 73% within 24 months

Answer 16

◦ 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

Answer 17

Dominant cultivable microbes ◦ Candida albicans 70% ◦ Prevotella intermedia 67% ◦ Campylobacter rectus 47% ◦ Aggregatibacter Actinomycetemcomitans 28% ◦ Porphyromonas gingivalis 23% ◦ Miscellaneous enteric bacteria

Answer 18

- Severe or Grade C Periodontitis - Uncontrolled/undiagnosed diabetes - ONJ (Osteonecrosis of the Jaw) - Severe immune suppression (Chemotherapy or leukemia)

Answer 19

Consult patient’s physician to prevent drug interaction **Non-surgical therapy**: ◦ Improve oral hygiene ◦ Debridement with hand instruments (to limit aerosols) ◦ 0.12% Chlorhexidine pre/post-treatment rinse **Antibiotics**: ◦ Metronidazole 250 mg 4X daily for 7-10 days ◦ Antifungal therapy if indicated **Surgical correction may be indicated**

Answer 20

* 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

Answer 21

◦ Necrosis and ulceration of the gingiva extending into the alveolar mucosa rapidly ◦ Exposure of necrotic bone with extension into osteomyelitis ◦ Tooth mobility ◦ Lymphadenopathy ◦ Fever ◦ Bacteremia, Septicemia

Answer 22

◦ Candida albicans ◦ Mixed gram negative anaerobic infection ◦ Miscellaneous enteric bacteria

Answer 23

- Severe or Grade C Periodontitis - Uncontrolled/undiagnosed diabetes - ONJ (Osteonecrosis of the Jaw) - Severe immune suppression (Chemotherapy or leukemia)

Answer 24

Consult patient’s physician to prevent drug interaction **Non-surgical therapy**: ◦ Debridement with hand instruments ◦ 0.12% Chlorhexidine pre/post-treatment rinse **Antibiotics**: ◦ Metronidazole 250 mg 4X daily for 7-10 days ◦ Antifungal therapy if indicated **Surgical correction may be indicated**

Answer 25

◦ A rapidly progressive, often gangrenous, infection from the mouth to the face ◦ Preceded by NG, NP, and NS ◦ Seen in impoverished and malnourished children (2-6 year olds) mostly in the poorest countries of Africa, Asia, and South America ◦ HIV infected individuals in some regions are affected (but not in other regions)

Answer 26

◦ Consult patient’s physician to prevent drug interaction ◦ Admit patient to hospital for IV antibiotics, fluids, nutritional supplementation, and supportive medical care. (Physician) ◦ Non-surgical therapy is done after patient’s general condition is stable. --- Debridement with hand instruments --- 0.12% Chlorhexidine pre/post-treatment rinse