WK 9: Perio & Acute Gingival Lesions Flashcards
Define Necrotizing gingivitis
A microbial disease of the gingiva in a n impaired host response characterized by necrosis and sloughing of the gingival tissue
what are the 3 clinical forms of Necrotizing Gingivitis
- Acute: most common
- Subacute: milde and more persistent form
- recurrent: Periods of revision and exacerbation.
List the predisposing factors for Necrotizing gingivitis
HIV
Immune suppression
poor nutrition (malnourishment)
tobacco
physiological stress
Describe oral symptoms or Necrotizing gingivitis
Extreme sensitivity to touch
constant radiating pain( made worse while eating)
metallic foul taste
pasty saliva.
Describe Clinical finding of Necrotizing gingivitis
Necrosis/Ulcer in Interdental papilla
gingival bleeding
pain
halitosis
pseudomembrane formation
What are the extra oral signs and symptoms of NG
Local Lymphadenopathy
Elevation in temperature
Severe cases
fever
high pulse rate
loss of appetite
Describe NG management
Gentle removal of placque and necrosis debris
Irrigation and rinse with Hydrogen peroxide 3%/ (5ml H20 + 5ml H2O2) 2x daily
Metronidazole 400mg, Orally Every 12hr, 3-5 days
analgesics : paracetamol, Ibuprofen
No smoking and OHI
Review patient 48-72hrs
periodontal examination
Thorough debridement when possible
no response= refer
Describe differences and when Necrotizing periodontitis can occur
In severely immune compromised patients Bone Sequestra can occur
Occurs due to >1 episodes of necrotizing gingivitis
OR
Occurs due to necrotizing gingivitis @ site previously affected by periodontitis
What is necrotizing stomatitis
Defined by the presence of soft tissue necrosis that extends beyond the gingiva with bone denudation (erosion) and formation of bone sequestrum.
Occurs in severely systemically compromised patients
what are other names for Noma (cancrumoris)
Necrotizing ulcerative stomatitis
gangrenous stomatitis
cancrum oris
Describe early clinical features of Primary hepatic gingivostomatitis
Diffuse (pus)
erythematous (red skin)
shiny involvement of Gingiva and adjacent oral mucosa
oedema
gingival bleeding
What occurs within 24 hours of infection with herpes
Vessicles rupture to form painful small ulcers, with a red elevated margin and depressed yellow central portion
What is management for herpes
DELAY ELECTIVE SURGIES
Antiviral medication
- Famciclovir 1500mg
-single dose
Give at sign of recurrence
Describe pericoronitis
Inflammation of the gingiva in relation to the crown of an incompletely erupted tooth
What is the most common site of pericoronitis
Most common site= impacted 3rd molar.
Space between the crown and overlying gingiva flap accumulates debris
clinical features of PCoronitis
Red swollen,
Radiating pain to ear, throat and floor of mouth
Foul taste
inability to close jaw
Trismus
fever
malaise
Describe the issue with the spread of infection and Pericorononitis with everyday function of the oral cavity.
Can spread posteriorly into the orophrangeal area and medially to the base of the tongue making it difficult to swallow.
Describe management strategies for PC
Cleaning the region (debridement)
antibiotics (systemic signs)
Operculectomy or Exo
Describe Periodontal Abscess
Acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus.
In what 2 types of patients can peridontal abscess occur
Those with a previous Perio pocket (periodontitis patient)
Those without a pre-existing periodontal pocket (non periodontal patient)
What are the common causes of Periodontal abscess
- Periodontal patients:
- Scaling, root planing, surgical Periodontal treatment - Non Periodontal Patient:
- Foreign bodies, harmful habits, orthodontic factors, gingival enlargement, alteration to root surface
Clinical features of a PA
Presence of generalized Perio with pocketing and bone loss
tooth is vital
overlying gingival erythematous
Tender & swollen
painful @ times (eating)
pus discharge via perio pocket
cervical lymphadenopathy
management of an abccess
drainage through sulcus
irrigation of accessed pocket
removal of foreign bodies
debreidgement of soft tissue wall
oral hygiene instructions
antibiotics
What are the contents of an abscess
bacteria, bacterial products,
inflammatory cells,
tissue breakdown products
serum
Get ready for Staging and grading of perio
Take a deep breath you got this.
Describe the 3 forms of periodontal health.
- periodontal health
A) clinical gingival health on intact periodontium
B) clinical gingival health on a reduced periodontium
- Stable perio patient
- non perio patient with recession
- Gingivitis
a) associated with direct biofilm alone
b) mediated by systemic or local risk factors
c) Drug influenced gingival enlargement
- Ex: phenytoin induced gingival hyperplasia
- Gingival diseases (non biofilm induced)
- Genetic development disorders
- specific infections
- Inflammatory immune conditions
- reactive processes
- neoplasms
traumatic lesions
What neuropeptide/ neurotransmitter is a key bio marker for Gingivitis
Substance P
What are 3 gingivitis modifying factors
Biofilm associated
Systemic ( sex hormones, smoking)
drug influenced
what are the 3 types of periodontitis
- necrotizing periodontitis
- periodontitis due to systemic diseases
- periodontitis
What are the primary features of perio
Loss of periodontal tissue support manifested as clinical attachment loss
radiographic bone loss
Pocketing
gingival bleeding
What are the requirements for a periodontal case
- Interdental clinical attachment loss (CAL) is detectable in >=2 non adjacent teeth
- buccal or oral CAL >= 3mm with pocketing >= 3mm is detectable in >=2 teeth
What are 5 causes for
Non Perio Clinical attachment Loss
Gingival recession of traumatic origin
dental caries extending to cervical area of tooth
distal CAL of 2nd molar due to malpostion or extraction of 3rd molar
endodontics lesion draining through the marginal periodontitis
vertical root fracture
What is required to differentiate between stable, remission and currently unstable periodontal status
what are differential periodontal diagnosis for periodontitis that need to be ruled out.
gingivitis
vertical root fracture
cervical caries
Describe stage 1 Periodontitis
describe stage 2 periodontitis
describe stage 3 periodontitis
describe stage 4 periodontitis
