Other periodontal Diseases and Conditions Flashcards
What are the 3 hallmarks of NUG and NUP?
- Punched out papilla
- Bleeding
- PAIN!!!
- NUP ONLY = attachment loss
What is the primary reason a person seeks treatment for NUG?
PAIN!
-patient cannot brush or eat
What are 2 “other” features that are most always seen with NUG and NUP?
- “pseudomembrane” (sloughed material)
2. Halitosis (terribly bad breath)
What separates NUG from NUP?
Attachment Loss!
NUP must include attachment loss, while NUP does not have AL
Name 5 characteristic that may be seen with NUP and NUG, besides 3 hallmarks, AL, halotosis and pseudomembrane (crappy question….I know)
- Lymphadenopathy
- Fever, malaise
- Poor oral hygiene
- Sequestrum formation
- Recurrence/Chronicity
Describe the significance of recurrence/chronicity in NUG/NUP
Having one episode of NUG/NUP greatly predicts the likelihood of getting it again
What is NUS?
Necrotizing Ulcerative Stomatitis – when NUG/NUP moves beyond the mucogingival junction
What is the prevalence of NUG/NUP in young adults of industrialized countries?
2-7%
What is the prevalence of NUG/NUP in young adults in developing countries?
Much higher than 7%
What is the prevalence of NUG/NUP in immunocompromised individuals (HIV, etc)?
1-28% (HAHAHAHA! I swear its not a joke!)
When diagnosing, what is the clinical presentation of NUG that you look for?
- Ulceration and necrosis of interproximal papillae
- Painful gingiva
- Bleeding (spontaneous, on slight provocation)
What 2 diseases must be eliminated during differential diagnosis of NUG/NUP?
- Primary Herpetic Gingivostomatitis
2. Oral mucosal diseases
How does Primary Herpetic Ginigvostomatitis differ from NUG/NUP?
- HIGH FEVER IS HALLMARK!
- Affects tongue and lips
- Round lesions (herpes)
(note, pain PLUS fever is especially seen in kids)
How does the etiology between NUG, PHG, and Desquamative differ?
NUG = Bacteria PHG = HSV (herpes simplex virus) Desquam = Immunologic
How do the most affected age groups differ between NUG, PHG, and Desquamative?
NUG = 15-30 (young adults) PHG = Children Desquam = Adults
How does the most affected site differ between NUG, PHG, and Desquamative?
NUG = Interdental papilla PHG = Gingiva and Mucosa Desquam = Gingiva and Mucosa
How do the signs/symptoms vary between NUG, PHG, and Desquamative?
NUG = Ulceration, pain, bleeding PHG = Vesicles, fever, foetor Desquam = Desquamation, pain, burning sensation
T/F: neither NUG, PHG, nor Desquamative are contageous
False! PHG is contageous (duh, its herpes)….the other 2 are not.
What are the 3 common gram (-) bacteria seen in NUG/NUP?
- Spirochetes (Tremponema)
- Fusobacterium
- P. Intermedia
What is unique about the behavior of the spirochetes and rods associated with NUG/NUP?
Invasiveness – these microbes actually invade the tissues
What 2 viruses are commonly associated with NUG/NUP?
- Human cytomegalovirus
2. HIV
What are the 5 biggest Host Factors that influence pathogenicity of NUG/NUP?
- Immunosuppression (systemic disease or malnutrition)
- Pre-existing ginigivitis (poor oral hygiene)
- Previous history NPD
- Psychological stress (including lack of sleep)
- Smoking (VIP!!!)
What is the most severe NPD seen in kids due to severe malnutrition?
Noma (don’t look it up, trust me its terrible)
What are the goals of periodontal therapies to treat NPDs?
- Eliminate disease activity
2. Avoid pain and general discomfort
What are the 3 common forms of acute treatment of NPDs?
- Debridement
- Oral rinses (H2O2-CHX)
- Antibiotics (only if needed, not for pain)
What are some further treatment options beyond the acute therapies?
- Further medical therapy
- Surgical therapy (defect elimination)
- Predisposing factor elimination
Define GINGIVAL abscess
- Localized, painful, rapidly expanding lesion in vital tissue
- Usually of sudden onset
- Generally limited to the marginal gingiva or interdental papillae (sulcus)
What is the usual etiology (cause) of gingival abscesses?
Irritation from foreign bodies forcefully embedded into previously healthy tissues
Define PERIODONTAL abscess
- Localized, purulent inflammation in the periodontal tissues
- Acute or chronic,
- Vital pulp
- Extension from pocket to perio tissues (not restricted to gingiva)
Where does a periodontal abscess tend to localize upon extension from the pocket to periodontal tissues?
Along the lateral root surfaces
When does localization of a periodontal abscess tend to occur?
Localization occurs when drainage through the pocket is impaired
What is a common reason for impaired drainage leading to periodontal abscess?
Post-treatment shrinkage of tissue over incompletely removed calculus
What 2 events/procedures often are followed by a periodontal abscess?
- Trauma (root fracture)
2. Endodontic perforation
What are the 3 types of periodontitis-related abscesses?
- Exacerbation of chronic lesion
- Post-therapy abscess
- Post-antibiotic abscess
When and to whom does a periodontitis-related abscess due to exacerbation of a chronic lesion occur?
- Occurs when chronic lesion becomes acute
- Seen in untreated patients and maintenance patients (recurrent infection)
When does a periodontitis-related Post-therapy abscess usually occur?
- Following SRP (calculus)
2. Following surgical therapy (calculus, foreign bodies)
Why might someone end up with a periodontitis-related post-antibiotic abscess?
- Taking antibiotics for OTHER reasons
- 40% get abscess within 4 weeks
- B/c MUST have mechanical debridement with antibiotics or get SUPER-INFECTION!!!!!
What are the 2 non-periodontitis-related abscesses?
- Foreign body impaction
2. Root morphology alterations
What are 2 common causes of non-periodontitis-related Foreign Body Impaction Abscesses?
- Oral Hygiene devices
2. Food Particles
What are 3 common causes of non-periodontitis-related Root morphology alteration abscesses?
- External root resorption
- Cemental (root) tears
- Iatrogenic (endodontic perforation)
What percent of periodontal abscesses are emergency conditions?
8-14%
How common are periodontal abscesses among patients treated for periodontitis?
27%
How common are periodontal abscesses in untreated patients with periodontitis?
> 50%
What is the most prevalent site for periodontal abscesses (which tooth) and why?
Molars, due to anatomical features such as multiple roots
What 2 bacteria tend to be found in periodontal abscesses?
- Periodontitis flora
2. P. gingivalis
What type of obstruction tends to prevent drainage and leads to abscess
Mechanical obstruction
What are the 4 MOST IMPORTANT features to look for when diagnosing as a periodontal abscess?
- Swelling
- Redness
- Suppuration
- Pain
What are ALL the features commonly associated with periodontal abscess for diagnosis
- Swelling
- Redness
- Suppuration (spontaneous or elicited)
- Pain
- Gingival tenderness
- Assoc. with deep pocket
- BOP
- mobility
- Radiographic bone loss
- Fever
- Malaise
- Lymphadenopathy
How does a periodontal abscess differ from a periapical abscess!!! KNOW! LIKELY TQ!
Peri-apical abscess = DEAD TOOTH
Periodontal abscess = tooth is usually vital
What are 2 important complications resulting from periodontal abscesses?
- Tooth loss
2. Systemic infection
What are the 2 mechanisms by which a periodontal abscess may become a systemic infection (travels to brain, blood, and/or vital organs)?
- Dissemination thru tissues DURING THERAPY
2. Dissemination thru bacteremia (untreated abscess) – upon brushing or chewing
What is the #1 site in the mouth for metastatic tumors? TQ!!
Gingiva – must biopsy if does not respond to tx within 2 weeks
What other diseases must you eliminate via differential diagnosis for a periodontal lesion?
- Periapical (endodontic) abscess
- Vertical root fractures
- Endo-perio abscess
- Osteomyelitis
- Tumor
Describe therapy prescribed for periodontal abscesses
- Acute lesion management:
- incision and drainage
- SRP
- Antibiotics
- Periodontal surgery
- Treatment of original/residual lesion
When should you include antibiotics in acute treatment of a periodontal abscess?
If there is systemic involvement
When should you include periodontal surgery in acute treatment of a periodontal abscess?
If related to a POCKET
