perio exam 2: ging diseases 1 Flashcards
is ging infmm always from an accumulation of pq around tooth surface?
NO!
desquamative gingivitis also
desquamative gingivitis (i think this implies ging from stuff not pq) 6 ex’s are…
- sp B origin
- viral origin
- fungal origin
- genetic origin
- systemic origin
- trauma
- sp B origin-general info
infective ging and stomatitis (what’s diff? latter=wiki says mouth and lips)
desquamative gingivitis
wiki “Unlike plaque-induced inflammation of the gums (normal marginal gingivitis), desquamative gingivitis extends beyond the marginal gingiva, involving the full width of the gingiva and sometimes the alveolar mucosa.[3]”
bacteria involved with sp B origin ging
Neisseria ginorrhea, Treponema pallidum, streps, mycobacterium chelonae
with sp B origin ging, lesions are accompanied by lesions elsewhere in the body. t/f
with sp B origin ging, lesions may or may not be accompanied by lesions elsewhere in the body
sp B origin ging: clinical presentation
variations:
fiery red edematous painful ulcerations
asymptomatic chancres, mucous patches, atypical non-ulcerated, highly inflamed ging
sp B origin ging: diagnosis
biopsy or microiological exam
viral origin
herpes simplex 1* &2 or varicella zoster
*most often 1
how does primary hepatic gingvostomatitis occur?
the virus penetrates the oral mucosal epi and neural ending and travels to the trigeminal ganglion
primary hepatic gingvostomatitis symptoms
painful, severe redness, ulcerations w/serofibrinous exudate, edema accompinied by stomatitis
viral origin ging characteristics (3)
- 1 wk incubation
- forms vesicles–>rupture–>coalesce–>leave fibrin coated ulcers
- healing 10-14 days
how long can the herpes virus stay latent in the trigeminal gang?
years!
is herpes virus found in periodontitis, ging, or NUD (NUG/NUP)
any
more primary infections of herpes occur at younger ages in industrialized countries t/f
f-older ages
percentage of ppl w/ primary hepatic gingvostomatitis who get recurring lesions?
20-40%
recurrent herpatic infections-herpes labialis more or less than 1/yr and where?
more (vermillion border and skin adjacent)
recurrent herpatic infections-triggers
stress, menstruation, uv, fever
recurrent herpatic infections: diagnosis
aphtous ulceration, ulcers attached to ging and hard palate
ging lesions of viral origin: can they be life threatening?
yes in immunocompromised pt’s
what’s the best way to collect and same from ging lesions of viral origin?
aspiration from vesicles
wiki: “Fine-needle aspiration biopsy (FNAB, FNA or NAB), or fine-needle aspiration cytology (FNAC), is a diagnostic procedure used to investigate superficial (just under the skin) lumps or masses. In this technique, a thin, hollow needle is inserted into the mass for sampling of cells that, after being stained, will be examined under a microscope. “
blood samples can determine an increased what with regard to the virus?
increased antibody titer
histopathology is not specific
tx of ging lesions of viral origin (2)
- careful pq removal to limit bacterial superinfection of the ulcerations
- systemic uptake of antivirals like aciclovir
ging lesions of viral origin (herpes zoster) are latent where?
the dorsal root ganglion (then later it just has 2nd and 3rd trigeminal gang branches…)
ging lesions of viral origin (herpes zoster) are bilateral ulcerations?
false. unilateral
ging lesions of viral origin (herpes zoster) clinical presentation
sm ulcerations on the tongue, palate, and ging
may or may not have skin lesions also
initial symptoms-pain and paresthesia
ging lesions of viral origin (herpes zoster): diagnosis
unilateral and super painful characteristic make it mostly “obvious”
ging lesions of viral origin (herpes zoster): tx
soft diet, rest, atraumatic pq removal, diluted chlorohexidine rinses. can be supplemented with antiviral thpy
ging from fungus-which three?
- candidosis
- linear ging erythema
- histoplasmosis
ging from fungus-candidosis albicans; who, when is there disease?
carry this routinely also (3-48% of healthy ppl); reduced host defenses-immunocomp or longer term antibiotics
ging from fungus-candidosis albicans is frequently isolated from who?
severe perio pts’ subgingival flora
ging from fungus-candidosis albicans-symptoms 3?
- painless or slightly sensitive
- red and white lesions
- lesions can be scraped or separated from the mucous
ging from fungus-candidosis albicans risks?
cancer pts w/ radiation, several anti B’s over several wks or months, diabetic pts, women, pregnancy and use of contraceptive
ging from fungus-candidosis albicans:diagnosis
culture on Nickerson’s medium @ room temp
microscopic exam of the smear material scraped from the lesion and stained
ging from fungus-candidosis albicans: tx
antimycotic/antifungal agents
ex. nystatin given as mouth rinse systemically
ging from fungus-candidosis albicans: characteristics are pseudomembranous or erythematous?
trick question! both! characteristics can be pseudomembranous or erythematous
ging from fungus-candidosis albicans:
typical clinical appearance:
redness of ? gingiva often associated with a ? surface
attached; granular
ging from fungus-candidosis albicans:
different types or oral mucosa manifestations: (4)
which is associated with pain?
which needs to be differentiated from leukoplakia?
which has elevations that are slightly elevated?
which have white patches that can be wiped off vs. type that something can’t be removed?
pseudomembranous - whitish patches can be wiped off
erythematous-red associated with pain
pq type-whitish pq that can’t be removed, need to differentiate from lekoplakia
nodular has elevated nodes of white or reddish color
ging from fungus-candidosis albicans: linear erythematous band limited to the free gingiva
linear ging erythema
ging from fungus-candidosis albicans: linear ging erythema type-does it bleed?
positive cutures for:
% of HIV associated ging sites?
% of unaffected sites of HIV seropositive pt’s?
% of healthy sites of HIV neg pt’s?
NO!
50% hiv ging sites
26% healthy sites of hiv pts
3% healthy ppl healthy sites
ging from fungus-candidosis albicans: linear ging erythema:
does it response well to improved oral hygiene? to scaling?
no
ging from fungus-candidosis albicans: linear ging erythema:
is the infmm response proportional to the pq accumulation?
no.
ging from fungus-candidosis albicans: linear ging erythema: tx
conventional thpy + cholorhexidine .12% rinse
antimycotic therapy if candida is detected
(if the heading is fungi origin-why are there cases it isn’t detected? other fungi?)
ging from fungus-histoplasmosis
will the pt know she/he has it?
yes-it affects the lungs 1st (my notes)
ging from fungus-histoplasmosis-where on pt?
acute or chronic pulmonary histo and a disseminated form in immunocompromised pts
it can be on any area of the oral mucosa but mainly the tongue
nodular or papillary and later may become ulcerative type of lesions with pain
ging from fungus-histoplasmosis: diagnosis is from?
clinical view and histopathology, systemic manifestations
ging from fungus-histoplasmosis: tx
systemic antifungal therapy
ging lesions of genetic origin: give an ex.
hereditary gingival fibromatosis
ging lesions of genetic origin: hereditary gingival fibromatosis: describe
diffuse gingival enlargement, diseae entity or part of a syndrome ex. hypertrichosis, mental or growth retardation, epilepsy, hearing loss, abnormalities of the extremities
can interfere w/or prevent tooth eruption
ging lesions of genetic origin: hereditary gingival fibromatosis: possible mechanisms
TGF-B1 fairs the accumulation of the dcm
might be located in chr 2
deletion of son of sevenless-1 gene on chr 2p21
(SOS)
ging lesions of systemic origin
allergic and traumatic reactions
other ging manifestations
mucocutaneous disorders
ging lesions of systemic origin: allergies are due to which two types of rxns?
type 1 or type 4 rxns
ging lesions of systemic origin: allergies with immediate type response are due to which type of rxns?
type 1 (type 4 is delayed (12-48 hrs post exposure)
ging lesions of systemic origin: allergies with IgE mediated type response are due to which type of rxns?
type 1
ging lesions of systemic origin: allergies can be due to what? give ex’s
dental restorative materials
(mercury, palladium, nickel, gold, zinc, chromium, acrylics and more)
oral hygiene products, chewing gum or food
(generally flavor additives or preservatives)
ging lesions of systemic origin: allergies can look like…
a diffuse fiery red edematus gingivitis. sometimes has ulcerations or whitenings
what can cause traumatic lesions?
chm, physical, or thermal
chm traumatic lesions
surface etching from chm w/toxic properties
ex’s: chlorohexidine-induced mucosal desquamation, acetylsalicylic acid burn, cocaine burn
incorrect use of caustics by the dentist
physical traumatic lesions
- hyperkeratsis-a white leukoplakia*-like frictional keratosis
- ging lacerations
- traumatic ulcerative ging lesion ex. brushing/flossing
*wiki “Leukoplakia in the mouth (oral leukoplakia), is defined as “a predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion”.[6] However, this definition is inconsistently applied, and some refer to any oral white patch as “leukoplakia”.[3] Leukoplakia and is a descriptive clinical term that is only correctly used once all other possible causes have been ruled out (a diagnosis of exclusion).[3] As such, leukoplakia is not a specific disease entity, and the clinical and histologic appearance are variable, i.e. the term has no specific histologic implications.[7]”
trauma: thermal injury
hot beverages, mostly on palatal ad labial mucosa
painful erythematous lesions, vesicles may develop
trauma: foreign body reactions
epi ulceration allows foreign bodies to enter ging ct. this can usually be detected on the x-ray
ex. amalgam tattoos, abrasives, toothpicks
ging lesions of systemic origin
- lichen planus
- pemphigoid
- pemphigus ?
- erythematus multiform
- lupus erythematosus
- drug induced mucocutaneous disorders
