Perio Flashcards
ANUG
Differential Diagnosis?
Treatment Planning?
ANUG
DIFFERENTIAL Diagnosis
- Primary herpetic gingivostomatitis
- Desquamative gingivitis
- Agranulocytosis
- Cyclic neutropenia
- Leukemia
- Ascorbic acid deficiency and gingivitis
TREATMENT (DCA)
- Perform DEBRIDEMENT under local anesthesia
- Remove pseudomembrane using cotton pellet dipped in chlorhexidine
- CHLOROHEXIDINE 0.12% twice daily
- Control pain with analgesics: ibuprofen 400-600 mg 3 times daily
-Prescribe ANTIBIOTICS if patient is immunocompromised (e.g., AIDS, leukemia, cyclic neutropenia) or in case of systemic involvement like fever, malaise and lymphadenopathy
AMOXICILLIN, 250 mg 3 x daily for 7 days and/or
METRONIDAZOLE, 250 mg 3 x daily for 7 days
- Patient COUNSELING should include instruction on proper nutrition, oral care, appropriate fluid intake, and smoking cessation
- Follow up with a comprehensive periodontal evaluation after resolution of the acute condition
ANUG
Cause?
Presentation?
FPS
-Bacterial involvement: FUSIFORM bacteria,PROVOTELLA intermedia, and SPIROCHETES invade the gingival tissues.
PRESENTATION
- Usually YOUNG ADULTS (age 18-30)
- Can be localized or generalized with RAPID/sudden onset and intense PAIN
- ULCERATED and NECROTIC papillary and marginal gingiva and cratering (punched out) of papillae
- BLEEDING gingiva with little or no provocation
- Fetid breath, yellowish-white or grayish slough “PSEUDOMEMBRANE” covering ulcerated papilla, lymphadenopathy, fever and malaise
Black Stain on Teeth (Bacterial)
Black tooth stain is a characteristic extrinsic discoloration commonly seen on the CERVICAL ENAMEL following the contour of the gingiva caused by CHROMOGENIC BACTERIA.
The black material is a FERRIC compound, most likely a ferric sulfide, which arises from the INTERACTION between HYDROGEN SULFIDE (produced by the bacteria in the periodontal environment) and IRON in the saliva or gingival fluid.
It can be diagnosed as pigmented, dark lines parallel to the gingival margin or as incomplete coalescence of dark dots rarely extending beyond the cervical third of the crown.
Though these stains are more prevalent among CHILDREN, in the present scenario their occurrence has been noticed in adult population also.
RECURRENCE rates of these stains are very HIGH. Almost 5 patients showed a recurrence within 1-2 months.
What are the etiological reasons for LINGUAL MANDIBULAR RECESSION?
Lingual recession in the area of mandibular anterior teeth is a commonly encountered and often ignored clinical scenario:
- Inflammation caused by CALCULUS
- prominent lingual FRENI
- deleterious habits
- The use of tongue JEWELRY was found to be strongly associated with the occurrence and severity of gingival recession in the mandibular anterior lingual region.
Local Aggressive Periodontitis (LAP)
PRIMARY teeth
FIRST MOLARS - INCISORS - LAAP
Localized Aggressive Periodontitis (LAP)
a rare form of inflammatory periodontal disease characterized by a RAPID rate of progression, dramatic attachment and bone loss, on very specific teeth (FIRST MOLARS and INCISORS), and an EARLY AGE of onset.
May have LESS plaque and inflammation*
almost always, ACTINOBACILLUS ACTINOMYCETEMCOMITANS (AA)
“LAAP”
TX: -Scaling/Root Planing -Extraction -Antibiotics: Amoxicillin / Metronidazole 7-10 days Azithromycin 3-5 days
Differences between Local Aggressive Periodontitis and General Aggressive Periodontitis.
LAP vs GAP
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- NUMBER of teeth
LAP is localised to first molar or incisor interproximal attachment loss. (I M)
GAP is the interproximal attachment loss affecting at least THREE permanent teeth OTHER than incisors and first molar. (3+ I M)
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Approximately 0.1% of white Caucasians and 2.6% of black Africans may suffer from LAP.
Bacteria in LAP?
approximately 65-75% of bacteria are GRAM-NEGATIVE BACILLI
- Actinobacillus Actinomycetemcomitans
“LAAP”
- Porphyromonas gingivalis.
Gingivitis in Children
Facts
Very common (especially adolescence)
Multifactorial
Up to 70% over the age of 7.
Peaks at Puberty (Hormones play a factor)
Starts with Plaque>Gingivitis>Periodontitis
Parental Participation up to the age of 8 due to lack of manual dexterity
Mouth Breathing, Crowded teeth, Erupting Teeth, and Braces may further aggravate inflamed gingiva
What is Aggressive Periodontitis characteristics?
4
- Involvement of multiple teeth with a distinctive pattern of periodontal tissue loss.
- A high rate of disease progression
- Early age of onset
- Absence of systemic diseases.
HYALURONIDASE role in dental infection?
What produces it?
GRAM-POSITIVE + / SPREAD
Capable of elaborating hyaluronidase are able to cause infections initiated at a mucosal or skin surface.
Hyaluronate is a major constituent of the ground substance of most connective tissues, particularly the skin, hyaluronidase may be an essential component in enabling the SPREAD of the pathogens from an initial site of infection.
