Tutorial Three

Question 1

necrotising ulcerative gingivitis clinical features

Answer 1

‘punched out’ appearance of papillae
pseudomembranous slough (white/yellow in colour)
gingivae bleed profusely
halitosis

Question 2

symptoms of necrotising gingivitis

Answer 2

pain
bad taste
regional lymphadenopathy
feverish
bad breath

Question 3

acute necrotising gingivitis vs acute necrotising periodontitis

Answer 3

only difference is periodontitis sees bone loss

Question 4

microbes implicated in necrotising periodontal conditions

Answer 4

fusiform bacteria
spirochetes

Question 5

aetiology of necrotising periodontal conditions

Answer 5

compromised immune system
HIV
heavy smoker
stress
adolescent
vaping

Question 6

treatment of necrotising gingivitis

Answer 6

superficial debridement with ultrasonic
CHX 0.2% MW 2x daily if too painful to brush
antibiotics should be given if lymphadenopathy or fever

Question 7

antibiotic of choice and regime for NUG

Answer 7

metronizadole
400mg
3x daily for 3 days

Question 8

if metronidazole contraindicated, what other antibiotic can be given for necrotising periodontal conditions

Answer 8

amoxicilin
500mg, 1 tablet, 3x daily for 3 days

Question 9

contraindications for metronidazole

Answer 9

consult BNF but 3 groups include,
alcoholics
warfarin
hepatic impairment

Question 10

why should metronidazole be avoided in alcoholics

Answer 10

disulfiram like reaction - nausea, palpitations, sweating
advised to not drink for at least 48 hours post metronizadole treatment

Question 11

why should metronizadole be avoided in patient taking warfarin

Answer 11

increases anticoagulation effects

Question 12

how soon should necrotising conditins be seen again

Answer 12

5-7 days
earlier if severe
once under control pocket chart then treat patient
high risk of recurrence

Question 13

why should cotton wool rolls be changed after etching

Answer 13

1 - moisture contamination
2 - phosphoric acid can burn mucosa if leached onto cotton wool

Question 14

potential systemic causes of desquamative gingivitis

Answer 14

primary herpes (primary herpetic gingivostomatitis)
crohns disease
leukemia (rare)

Question 15

potential inflammatory causes of desquamative gingivitis

Answer 15

lichen planus
vesicullobullous diseases

Question 16

potential infectious causes of desquamative gingivitis

Answer 16

primary herpetic gingivostomatitis

Question 17

treatment of primary herpetic gingivostomatitis

Answer 17

in non immunocompromised patient; bed rest, hydration, analgesics, antimicrobial MW (CHX or hydrogen peroxide)
in immunocompromised; as above + aciclovir

Question 18

aciclovir prescription for immunocompromised patient (or severe infection in non compromised) with primary herpetic gingivostomatitis

Answer 18

200mg tablets
1 tablet, 5x daily for 5 days

Question 19

name 3 drugs that may cause gingival hyperplasia

Answer 19

Ca channel blockers (amlodipine)
anticonvulsants (phenytoin, valproate)
immunosuppresants

Question 20

if young patient presents with gingival hyperplasia, good OH and no hyperplasia risk drugs what should be done

Answer 20

sent for urgent blood tests (same day)
leukemia risk