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BDS3 Periodontology > Periodontal Treatment 2 > Flashcards

Periodontal Treatment 2 Flashcards

1
Q

Necrotising periodontal disease can be split into 3 different categories. What are these?

A
  • Necrotising gingivitis
  • Necrotising periodontitis
  • Necrotising stomatitis
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2
Q

What does necrotising gingivitis affect?

A
  • this is a disewase which is restricted to gingival tissue (soft tissue)
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3
Q

What does necrotising periodontitis affect?

A
  • This involves bone so we can observe clinical attachment loss during clinical examination
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4
Q

What does necrotising stomatitis affect?

A
  • This is a disease that is not restricted to only periodontal tissue but also oral mucosa
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5
Q

Why are mecrotising ulcerative gingivitis and periodntitis described as acute?

A
  • because acute describes the nature of the diease

- Tend to be quite severe symptoms

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6
Q

What is Fusospirochetosis?

A

Thsi describes the bacterial flora which are involved

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7
Q

Give the different diagnoses of necrotising periodontal diseases? (10)

A
  • Necrotising gingivitis
  • Nectorising periodontitis
  • Necrotising stomatitis
  • Acute necrotising ulcerative gingivitis
  • Acute necrotising ulcerative periodontitis
  • Fusospirochestosis
  • Trench mouth
  • Vincent’s gingivitis, gingivostomatitis, infection
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8
Q

Are Vincent’s gingivitis and Vinvent’s angina the same thing?

A
  • No, they occur independenctly of each other
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9
Q

What is Vincent’s angina?

A
  • IT is a disease of the throat, not the periodontium
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10
Q

What is necrotising periodontal disease?

A
  • IT is the most severe inflammatory periodontal disorder caused by plaque bacteria
  • It is rapidly destructive and debilitating
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11
Q

What are the main features of necrotising periodontal disease? (4)

A
  • Painful, bleeding gums and ulceration and necrosis of the interdental papilla
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12
Q

Necrotising periodontal disease is an opportunistic infection. What does this mean?

A
  • Caused by the bacteria inhabiting healthy oral cavity
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13
Q

How often is NPD seen in developed and developing countries? (in percentage)

A
  • 1% in developed

- 27% in developing

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14
Q

What is necrotising ulcerative gingivitis?

A
  • Acute necrotising ulcerative gingivitis, (ANUG), or simply necrotising gingivitis, is a common, non-contagious infection of the gums. If improperly treated NUG may become chronic and/or recurrent
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15
Q

What is necrotising ulcerative periodontits?

A
  • NUP/NP/acute necrotising ulcerative periodontitis is where the infection leads to attachemnt loss (so the bone is involved)
  • NUP may be an extension of NUG into the PDL, although this is not completely proven. Maybe both diseases develop without connection
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16
Q

What is necrotising stomatitis?

A
  • Progression of NUP into tissues beyond the mucogingival junction characterizes NS - mostly in malnutrition and HIV infection - may result in denudation of the bone leading to osteitis and oro-antral fistulas
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17
Q

What is Cancrum oris?

A
  • This is a more severe form of necrotising stomatitis
  • IT is a necrotising and destructive infection of the mouth and face, and therefore not strictly speaking a periodontal disease. In modern times, this condition usually occurs almost exclusively in malnourished children in developing countries. It may be disfiguring and is frequently fatal. IT has been suggested that all cases of cancrum oris develop from pre-existing NUG, but it is not confirmed. Furthermore, the vast majority of cases of NUG and NUP will not progress to the more severe forms, even without treatment - so we think it develops independently of NUG and NUP
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18
Q

Do we have any tests that would allow us to confirm our diagnosis of periodontal disease?

A
  • No, we have no biological test that will allow us to confirm our diagnosis but the symptoms are very characteristic
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19
Q

Give the common symptoms of someone with necrotising ulceratice periodontal disease? (4)

A
  • Ulcerated and necrotic papillae and gingival margin resulting in a characteristic punched-out appearance
  • The ulcers are covered by a yellowish, white or grey slaim - which has been termed pseudomembrane - term is misleading and should no tbe used - no coherence only slime made of fibrin, necoritc tissue, leucocytes, erythrocytes and mass of bacteria
  • LEsions develop quickly
  • Lesions are veyr painful - sevrer pain
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20
Q

What is the bleeding like with someone with NUP?

A
  • Bleeding readily provoked
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21
Q

Where are the first lesions of NUP usually found?

A
  • The first lesions are most often seen interproximally in the mandibular anterior region
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22
Q

Foetor ex ore is a common symptom of NUP, what is this?

A
  • Foul smellign odour coming from the mouth
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23
Q

In NUP, what are the ulcers commonly associated with?

A
  • The ulcerations are often associated with deep pocket formation as gingival necrosis coincides with loss of crestal alveolar bone
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24
Q

In relation to lymph nodes what might we see in NUP?

A
  • Swelling of the lymph nodes, particularly in advanced cases
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25
Q

How can we associate between NUP and herparic gingivostomatitis?

A
  • There is usually no elevation of the body temperature in NUP but there is in HG
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26
Q

Why is the diagnosis of NPD not based on any test?

A
  • Biopsy - histopathology not pathognomic (characteristic) for NDP
  • Microbiolofy also not characteristic
  • Constant flora = Treponema sp. Selenomonas sp. Fusobacterium sp., prevotella intermedia
  • (This is normal flora of the mouth - they will always be there so if we used a test we would also get a positive result in healthy patients - this is why it is not an infective disease because these bacteria are always there - only in the condition in which they thrive they are developing in greater numbers which is what causes the disease)
  • Variable flora: heterogenous array of bacterial types
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27
Q

What is the aetiology of NDP ?

A
  • Bacteria
28
Q

What is the aetiology of HG?

A
  • Herpes simplex virus
29
Q

What age range does NDP commonly affect?

A

15-30 years

30
Q

What age range does HG commonly affect?

A

Frequently children

31
Q

At what site does NPD commonly affect?

A
  • Interdental paillae

- Rarely outside the gingivae

32
Q

At what site does HG commonly affect?

A
  • Gingiva and the entire oral mucosa
33
Q

What symptoms are common in somwone with NPD? (3)

A
  • Ulcerations and necrotic tissue and yeelowish white plaque
  • Foetor ex ore
  • Moderate fever may occur
34
Q

What symptoms are common in someone with HG? (3)

A
  • Multiple vesicles which disrupt, leaving small, round fibrin-covered ulcerations
  • Foetor ex ore
  • Fever
35
Q

How long does NDP tend to last?

A

1-2 days if treated

36
Q

How long does HG tend to last?

A

1-2 weeks

37
Q

Is NPD contagious?

A

No

38
Q

Is HG contagious?

A

Yes

39
Q

Can you get immunity to NPD?

A

No

40
Q

Can you get immunity to HG?

A

Partial

41
Q

Can you get full healing of NPD?

A
  • Destruction of periodontal tissue remains
42
Q

Can you get full healing of HG?

A
  • No permanent destruction
43
Q

In developed countries, What are the risk factors for NPD? (6)

A
  • NPD occurs mostly in young adults with predisposing factors such as psychological stress, sleep deprivation, poor OH, smoking, immunosuppression (HIV and leukaemia) and/or malnutrition
44
Q

In developing countries, what is the common risk factor for acute necrotising ulcerative gingivitis?

A
  • Malnourished children
45
Q

Treatment of acute disease is by debridement and antibiotics, usually metronidazole. Poor OH and other predisposing factors may need to be corrected to prevent recurrence. Explain the treatment? (5)

A
  1. Ultrasonic debridement (to remvoe the necrotic tissue)
  2. Pain prevents patient from brushing - instead use 0.2% chlorhexidine mouthwash twice daily
  3. Patients with malaise, fever and lassitude, lack of response to mechanical therapy with impaired immunity:
    - Give 200mg metronidazole TID (3 times daily) for 3 days (SDCEP)
    - OR 400mg Metronidazole TID for 3 days
  4. Smoking cessation, vitamin supplementation and diatery advice (to reduce the risk factors)
  5. In case of necrotising periodontitis, after remedy of the acute symptoms, you need to carry out hygiene phase therapy to treat periodontal disease and put in inactive phase
46
Q

Give examples of 2 adjuncts to treatment of periodontitis?

A
  • Systemic and topical antimicrobials

- Host modulation therapies

47
Q

What is periodontal health?

A

The outcome of the balance between bacteria of the dental plaque and the gost immune system
- If there is an imbalance of these 2 parts we can see an increase in periodontal development

48
Q

What is periodontal disease?

A

An imbalance between microbiome and the host immune system

49
Q

What are the possible treatment strategies for periodontal disease and what do they target? (3)

A
  • Mechanical disruption (targeting biofilm)
  • Systemic antibiotics or local antimicorbials (targeting biofilm)
  • Host modulation therapy (targeting function of the immune system)
50
Q

One form of mechanical disruption of the biofilm is oral hygiene instruction. What is included in this? (3)

A
  • Tooth brushing technique (modified bass)
  • Flossing
  • Interndental brushes
51
Q

One form of mechanical disruption of the biofilm is supra and sub gingival plaque control. What is included in this? (2)

A
  • Can do this with supra and sub-gingival scaling and root surface debridement
52
Q

When would we use systemic antibiotics for treatment of periodontal disease?

A
  • Systemic antibiotics in periodontal treatment are not the first line treatment and if used in select cases are onloy allowed once combined with mechanical disruption of biofilm
  • Using these alone is inefficient and leading to the development of antibiotic resistance
53
Q

What is a biofilm?

A

A biofilm is an aggregate of microorganisms in which cells adhere to each other on a surface. These adherent cells are embedded within a self-produced matrix of extracellular polymeric substance - DNA, proteins, polysaccharides
- resistance to antibiotics, antibactieral agents, hidden from immune system of the host

54
Q

In which cases would we consider to treat someone with systemic antibiotics and mechanical disruption of the biofilm? (2)

A
  • Aggressive periodontits (old classification)

- Young people with grade B/C (fast progressing periodontitis) (new classification)

55
Q

What is the treatment protocol (soecialist treatment) - only in patients after initial HPT and with excellent oral hygiene? (3)

A
  1. OH
  2. Supragingival scaling and RSD of all sites indicated in pocket chart - short time as possible within one week, in our hospital within one day
  3. Start the antiboitic regime on the morning of the first RSD visit
56
Q

What are the possible antibiotic regimes we might put a patient on on the morning of the first RSD visit? (4)

A
  • 500mg amoxicilin 3 times a day for 7 days
  • 200mg BSP (400mg) metronidazole 3 times a day for 7 days
    (top 2 are most popular)
  • Patient allergic to amoxicillin or on warfarin:
  • 100mg doxycycline; once a day for 21 days with 200mg loading dose during first day
  • 500mg Azithromycin; one a day for 3 days
57
Q

What is one contraindication of amoxicilin?

A
  • Allergies
58
Q

What are possible contraindications of metronidazole? (3)

A
  • Alcohol intake
  • Increase anti-coagulant effect of warfarin
  • Pregnancy
59
Q

What is one contraindication of doxycycline?

A

Pregnancy - tetracycline staining of the teeth

60
Q

What are advantages of local antimicrobials? (7)

A
  • Reduced systemic dose
  • High local concentration
  • Superinfections, such as with Clostritium difficile, unlikely
  • Site specific
  • Patient complaince not an issue as applied by healthcare provider
  • Can utilize agents which can’t be utilized systemically e.g. chlorhexidine
61
Q

What are disadvantages of local antimicrobials? (3)

A
  • Expensive
  • Still require RSD or biofilm disruption
  • Limited indications
62
Q

Give an example of a local antimicrobial?

A

Chlorhexidine

63
Q

Give examples of indications for using local antiseptics to treat periodontal disease? (4)

A
  1. Only persisting pockets >5mm
  2. Always with RSD
  3. Only in isolated pockets - (if many deep periodontal pockets in one area - OFD or systemic antibiotics combined with RSD is more beneficial)
  4. In case of periodntal abscesses - after evacuation of pus and RSD
64
Q

What is the advantage of antibiotics in the from of local antimicrobials?

A
  • They are developed in microspheres - there is no fluctuation of the concentration of the antibiotic so we have very stable dosage in the tissue which is very good because this is protecting us against the development of resistance
65
Q

Give examples of 3 local antimicrobials wich are antibiotics?

A
  1. Arestin - 1mg minocycline HCL microspheres
  2. Atridox - doxycycline hyclate 10%
  3. Elyzol - 25% metronidazole
66
Q

Read last few slides on alternative therapies

A

:)

BDS3 Periodontology (3 decks)

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