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BDS 3: Periodontics > S4 Recognising periodontitis and necrotising diseases > Flashcards

S4 Recognising periodontitis and necrotising diseases Flashcards

1
Q

Define periodontitis.

A

A chronic multifactorial inflammatory disease associated with dysbiotic biofilm.
Progressive destruction of the tooth supporting stuctures.

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2
Q

Name the clinical signs of periodontitis.

A
  • Gingival inflammation
  • Bleeding on probing
  • Pocket formation
  • Gingival recession
  • Alveolar bone resorption
  • Mobility and drifting
  • Tooth loss
  • Interdental recession (black triangles)
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3
Q

Describe the “advanced lesion”.

A
  • Destructive
  • Loss of CT attachment (collagen and PDL)
  • Ulceration of the junctional epithelium and apical migration (pocket)
  • Extension of subgingival anaerobic plaque
  • Chronic inflammatory infiltrate: lymphocytes and plasma cells
  • Osteoclast action causing alveolar bone resorption
  • Balance between damage and repair is lost
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4
Q

What type of microorganisms are present in periodontitis?

A

Red complex microorganisms:
- Porphyromonas gingivalis
- Tannerella forsythia (Previously known as B. forsythus)
- Treponema denticola

Aa is also associated with aggresive forms of periodontitis, but is not a red complex microorganism.

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5
Q

How are periodontal diseases classified into 3 major groups?

A
  • Necrotising periodontal diseases
  • Periodontitis
  • Periodontitis as a manifestation of sytemic disease
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6
Q

Describe how periodontitis is diagnosed.

A

1) Identify the nature of the disease: biofilm induced gingivitis, periodontitis or other disease
2) Extent of periodontitis: localised or generalised (>30%), if they don’t have a lot of teeth remaining, were these teeth lost due to periodontitis?
3) Pattern: gives an indication of the progression of the disease/how aggressive, can be a molar/incisor distribution, horizontal or vertical bone loss?
4) Staging: early/mild, moderate, severe, very severe (I,II,III,IV)
5) Grading: disease progression rate, A, B, C
6) Status: stable/in remission/unstable
7) Associated risk factors: smoking, diabetes, OH

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7
Q

Describe how periodontitis is staged.

A

Staged according to bone loss.
Periapical radiographs are typically needed rather than BWs to determine bone loss extent more accurately.

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8
Q

Describe how periodontitis is graded.

A

Graded by dividing bone loss percentage at worst site by patient age.
Determines the rate of progression.
- <0.5 = grade A (slow)
- 0.5-1.0 = grade B (moderate)
- >1.0 = grade C (rapid)

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9
Q

What is molar incisor pattern periodontitis/localised aggressive periodontitis?

A
  • Rare type of aggressive periodontitis affecting the incisors and first molars
  • Affects adolescents and young adults, minimal plaque, good oral hygiene and non-associated medical history
  • Rapid attachment loss (grade B or C)
  • Rapid rate of progression
  • Possible hereditary links, seems to affect members of the same family

Cause is not completely understood.

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10
Q

What are the clinical features of necrotising diseases?

A
  • Intensely red gingivae
  • Spontaneous bleeding
  • Extensive necrosis of soft tissues with yellow/white slough
  • Punched out papillae
  • Pain
  • Odour
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11
Q

What is the aetiology of necrotising diseases?

A
  • Systemic immune deficiency, previously common in patients with AIDS
  • Malnutrition
  • Stress
  • Smoking
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12
Q

Describe the microbiology of necrotising diseases.

A

Spirochaetes and Fusiforms.

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13
Q

Name the necrotising diseases in periodontics.

A
  • Necrotising ulcerative gingivitis
  • Necrotising ulcerative periodontitis
  • Necrotising stomatitis
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14
Q

What is NUG?

A

Necrotising ulcerative gingivitis
- An infection characterised by gingival necrosis presenting as “punched out” papillae, with bleeding and pain

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15
Q

Describe the epidemiolgoy of NUG.

A
  • Prevalence has decreased over the past 20 years
  • Seen mostly in young adults, mean age 23 years
  • More common in Caucasians
  • Affects men and women equally
  • More common during autumn and winter months
  • Associated with stress, more common in students e.g. during exams
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16
Q

What are the predisposing factors for NUG?

A
  • Poor oral hygiene and pre-existing gingivitis
  • Emotional stress
  • Smoking
  • Poor nutrition/malnutrition
  • Immunosuppression
17
Q

Describe the aetiology of NUG.

A
  • An opportunistic infection caused by anaerobic commensal bacteria
  • Spirochaetes and fusiform Bacilli = ‘Fusospirochaetal complex’
  • Bacteria invade the gingival tissues
  • The exact trigger is not fully known, if a patient repeatedly presents with NUG you would want to liaise with the GP as it could be due to immunosuppression
18
Q

What are the symptoms of NUG?

A
  • Sudden onset of painful gingivae
  • Gingival bleeding
  • Metallic taste
  • Halitosis
  • Malaise possible (generally feeling unwell)
19
Q

What are the signs of NUG?

A
  • Erythematous marginal gingivae
  • May be localised or generalised
  • Lower anterior region is a commonly affected site
  • Necrotic ulceration produces yellow/grey slough, commonly affecting the interdental papillae giving punched out appearance
  • Raw, bleeding mucosa beneath slough
  • Painful to probe
  • Bleeding on probing
  • Lymphadenopathy may be present
20
Q

How is NUG managed at the first appointment?

A
  • Immediate management: aiming to relieve pain
  • Definitive management: address cause and prevent recurrence
  • Debridement of the effected gingival margin is essential at the initial emergency appointment
  • LA is advisable
  • Ultrasonic to remove necrotic slough
  • Soft toothbrush to use at home
  • Hydrogen peroxide mouthwash (Peroxyl)
  • Abx as an adjunct where there is evidence of systemic involvement: Metronidazole 400mg TDS for up to 5 days
21
Q

How is NUG managed approx. 1 week after the first appointment?

A

After 1 week, symptoms should have resolved.
- Improve existing OHI, use interdental aids
- Meticulous sub and supra gingival scaling
- Remove plaque retentive factors
- Smoking cessation advice
- Perio surgery to improve gingival contour if there are poor aesthetics
- Be suspicious of an underlying systemic disorder of the immune system, particularly if a patient repeatedly presents with NUG
- Patients with unexplained recurrences or persistent NUG should be assessed with blood tests, inform GP

22
Q

What is NUP?

A

Necrotising ulcerative periodontitis.
- An infection characterized by the necrosis of gingival tissues, periodontal ligament and alveolar bone.
- If NUG is inadequately treated, NUG may develop into NUP.
- May be a feature of an HIV infected patient (somewhat historic).

23
Q

What are the predisposing factors, aetiology and symptoms of NUP?

A

Same as NUG:
- Poor OHI, stress, smoking, poor nutrition, immunosuppression
- Opprotunistic infection, Fusospirochaetal complex, bacteria invade gingival tissues
- Sudden onset of paingul gingivae, bleeding, metallic taste, malaise, halitosis

24
Q

What are the signs of NUP?

A

Same as NUG, plus:
- Severe deep aching pain
- Very rapid rate of bone destruction
- Deep pocket formation not evident immediately

25
Q

What is the management for NUP?

A
  • Local debridement
  • Anaesthetic as required
  • OHI
  • Oral rinses: chlorhexidine gluconate, hydrogen peroxide or water
  • Pain control, analgesic advice
  • Antibiotics for systemic involvement, metronidazole (400mg TDS up to 5 days)
  • Modify predisposing factors e.g. smoking cessation, OHI, stress
  • Frequent follow-ups until resolution of symptoms

Comprehensive periodontal chart following acute phase.

25
Q

What condition may follow on from NUP?

A

Noma (cancrum oris)
- A disfiguring condition that may follow on from NUP, mostly in developing parts of the world
- Extensive necrosis and destruction of facial tissue
- Associated with severe malnourishment

BDS 3: Periodontics (8 decks)

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