Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Periodontics > Necrotizing Periodontal Diseases > Flashcards

Necrotizing Periodontal Diseases Flashcards

1
Q

Necrotizing Periodontal Diseases
Clinical Presentation
Sudden onset
and it can become a
“—”
Characterized by
(2)

A

chronic condition

gingival tissue
necrosis and
ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Necrotizing Periodontal Diseases

A

A rare and destructive form of
periodontal disease caused by
microorganism in the context of
an impaired host response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

skipped
The 1989 Classification
stages (7)

A

Stage 1: Necrosis of the tip of interdental papillae
Stage 2: Necrosis of entire papillae
Stage 3: Necrosis extends to marginal gingiva
Stage 4: Necrosis extends to attached gingiva
Stage 5: Necrosis extends to labial/buccal mucosa
Stage 6: Necrosis and exposing alveolar bone
Stage 7: Necrosis perforates facial skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The 2017 Classification
Forms of Periodontitis (3)

A

necrotizing gingivitis
necrotizing periodontistis
necrotizing stomatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

skipped
Epidemiology
Prevalence/Incidence
* —% in general populations
* —% in military personnel
* —% when it was close to the end of WW2
* —% in students
* —% in HIV/AIDS patients

A

0.5 - 3.3
0.2 - 6.2
4%-20.6
0.9 - 6.7
0 - 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

skipped
0 - 30 % in HIV/AIDS patients
(3)

A
  • Children (2.2‐5.0%)
  • HIV adults (0.0–27.7% for NG and 0.3–9.0% for NP)
  • HIV/AIDS patients (10.1–11.1% for NG and 0.3–9.0% for NP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

skipped
Spirochetes and fusiform bacteria
(4)

A

P. intermedia
Treponema
Selenomonas
Fusobacterium species

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

skipped
Specific features in HIV
(3)

A

Candida albicans
Herpes viruses
Superinfecting bacterial species

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

skipped
Systemic modifying factors

A

PMN function
Pre-exsisting systemic disease
- Leukemia
- Leukopenia
- HIV/AIDS
Previous history of NPD
Pre‐existing gingivitis
Young age and ethnicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

skipped
Environmental
Determinants

A

Mulnutrition
Stress
Insufficient sleep
Smoking/alcohol
consumption
Inadequate oral
hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Stress/Anxiety/Depression
+ Negative Life Event
(3)

A

Increased Serum Cortisol
Immune System Depression
Necrotizing Gingivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • HIV:
  • AIDS:
  • Marked shift of — ratio
  • normal ratio is –
A

Human Immunodeficiency Virus
Late stage of the HIV infection
CD4/CD8
2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AIDS: Late stage of the HIV infection
* Marked shift of

A

CD4/CD8 ratio
* normal ratio is 2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • AIDS: Late stage of the HIV infection
  • Definition (one of the following)
    (2)
A
  • CD4 count <200 cells/mm3 in an HIV+ patient
  • HIV+ patients with ≥ one opportunistic infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • HIV+ patients with ≥ one opportunistic infection
    (3)
A
    • Pulmonary TB
    • Recurrent pneumonia
    • Invasive cervical carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HIV/AIDS
Disease severity based on CD4 counts (T-helper cell)
Normal count:
Preventive therapy:
Infection occur frequently
HIV+ becomes AIDS:
Significant changes occur:

A

900-1800
≤500
200-500
≤200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HIV/AIDS
Opportunistic infection CD4 count in blood
(cells/mm3)
Usually no signs of
immunosuppression-associated disease:
Staphylococcal skin infections,
candidiasis:
Herpes zoster, oral hairy leukoplakia:
TB, histoplasmosis, Kaposi’s sarcoma,
herpes simplex, etc:
Cytomegalovirus:

A

> 400-500
301-400
201-300
101-200
0-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Viral count

A

Monitor status of disease,
guide therapy, prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Absolute Neutrophil Count

A

Require antibiotic prophylaxis
when ANC<500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Platelet count

A

No procedures if below 50,000
(Normal 150,000-450,000)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

skipped
ANC calculation

A

WBC(in 1000s) X (% segmented [mature] + % bands [immature])

If the WBC is 4.3, with segmented % of 48%, and 2% bands, then the ANC is 4.3 x (.5)=2,150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

HIV/AIDS
Oral lesions
(7)

A
  • Candidiasis
  • Viral lesions
  • Major aphthous ulcers
  • Necrotizing gingivitis
  • Linear gingival erythema
  • Necrotizing periodontitis
  • Neoplasms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  • Neoplasms
    (3)
A
  • Oral hairy leukoplakia
  • Kaposi’s sarcoma
  • Non-Hodgkins lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When to premeditate
HIV/AIDS patients for
invasive procedures?
A. When CD4 count is less than 200 cells/mm3
B. When platelet count is less than 50,000
C. When Absolute Neutrophil Count is less than 500
D. When the viral count is less than 500

A

C. When Absolute Neutrophil Count is less than 500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Light Microscopy
Necrotizing Gingivitis

A

It shows nonspecific acute inflammatory reaction
surrounding an ulcer within the stratified squamous
epithelium and the gingival connective tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Light Microscopy
Necrotizing Gingivitis
Identical to
Except the

A

a necrotizing gingivitis lesion
destruction of the underlying periodontium

27
Q

Clinical Feature: Linear erythema
Tissue involved
Observation

A

Underlying
connective tissue
It is hyperemic with numerous
engorged capillaries and
dense infiltration of PMNs

28
Q

Clinical Feature: Pseudomembrane
Tissue involved
Observation

A

Surface epithelium
It is destroyed and replaced
by a meshwork of fibrin,
necrotic epithelium, PMNs
and various types of
microorganism.

29
Q

Microscopic zones
(4)

A

Bacterial zone
Neutrophil‐rich zone
Necrotic zone
Spirochetal infiltration zone

30
Q

Bacterial smear
(2)

A
  • Spirochetes
  • Rods
31
Q

Phagocytosis

A
  • Neutrophil approach
    the bacterial zone
32
Q

Assessment
* Find out — factors
* — findings account for diagnosis of NPD
* — assessment in
atypical presentation or non-responding cases

A

predisposing
Clinical
Microbiological or biopsy

33
Q

Signs and Symptoms
Primary
Symptoms & Signs
(3)

A

gingival necrosis
gingival bleeding
pain

34
Q

Other Common
Symptoms & Signs
(4)

A

Pseudomembrane
Halitosis
Lymphadenopathy
Fever

35
Q

Signs and Symptoms
* Necrosis and ulcer in the —
* — spontaneously or while brushing
* Mild to moderate —
* — formation
* Halitosis
* May have aggressive tissue destruction/bone loss
* Severe gingival recession
* Hypersensitivity
* Suppuration
* Dysgeusia
* Low-grade —
* —

A

interdental papilla
Bleeding
pain
Pseudomembrane
fever
Lymphadenopathy

36
Q

Necrotizing Gingivitis
Clinical Characteristics
(3)

A
  • Not Contagious
  • Age onset is generally
    15-30 years old
  • Strong relationship
    between onset of
    disease and level of
    stress/anxiety
37
Q

Necrotizing Gingivitis
* Respond to
* –% patients exhibit a
localized defect in
neutrophil chemotaxis
and/or phagocytosis

A

antibiotic
and non-surgical
periodontal therapy

75

38
Q

Necrotizing Gingivitis
Clinical Symptoms & Signs
(7)

A
  • Necrosis and ulcer in the
    interdental papilla (94–100%)
  • Gingival bleeding (95–100%)
  • Pain (86–100%)
  • Pseudomembrane formation
    (73–88%)
  • Halitosis (84–97%)
  • Adenopathy (44–61%)
  • Fever (20‐39%)
39
Q

Necrotizing Gingivitis
Microbiology
(4)

A

Fusobacterium nucleatum
Prevotella intermedia
Treponema spp.
Spirochetes (Selenomonas spp.)

40
Q

Differential Diagnosis:
Herpetic Gingivostomatitis
* Primary herpetic gingivostomatitis (PHG) is frequently
mistaken for
* Keys to differentiate: (4)

A

NPD
Age, body temperature, lesion
site, clinical symptoms

41
Q

NPD
Etiology
Age
Site
Symptoms (3)
Duration
Contagious
Immunity
Healing

A

Bacteria
15-30 years
Interdental papillae, Rarely outside gingival
*Ulcerations, necrotic tissue and
a yellowish-white plaque
*Foetor ex ore
*Low grade fever
1-2 days if treated
No
NA
Destruction of periodontal tissue
remains

42
Q

PHG
Etiology
Age
Site
Symptoms (3)
Duration
Contagious
Immunity
Healing

A

Herpes simplex virus
Frequently children
Gingiva and entire oral mucosa
*Multiple vesicles which disrupt,
leaving small round fibrin-
covered ulcerations
*Foetor ex ore
*Fever ( >38 oC)
1-2 weeks
Yes
Partial
No permanent destruction

43
Q

Necrotizing Gingivitis?
Primary Herpetic Gingivostomatitis?
A. NG, because the gingival ulceration is limited to the gingiva
B. NG, because there is pseudomembrane
C. PHG, because the small round fibrin-covered ulcerations
are mainly on the papilla
D. PHG, because the small round fibrin-covered ulcerations
are on the gingiva with most of papilla intact

A
44
Q

Differential Diagnosis:
HIV association
(3)

A

Linear gingival erythema
Intense erythematous marginal gingivitis
May have profuse BOP

45
Q

Linear gingival erythema
(3)

A
  • Prior to other
    opportunistic infections
  • Incidence of about
    30-40% of AIDS cases
  • Seen when CD4 count
    > 200 cell/mm3
46
Q

Linear gingival erythema
* Microbiology
(5)

A
  • Fusobacterium nucleatum
  • Porphyromonas gingivalis
  • A. actinomycetemcomitans
  • Treponema spp.
  • Candidas (evidence showed
    it may be the primary
    etiology)
47
Q

Necrotizing Gingivitis
Treatment
Non-surgical therapy:

A

Improve oral hygiene and debridement
0.12% Chlorhexidine pre/post-treatment rinse

48
Q

Necrotizing Gingivitis
Treatment
Antibiotics:

A

Metronidazole 250 mg 3x daily for 7 days (first choice)
Or Amoxicillin, 500 mg 3x daily for 7 days

49
Q

Necrotizing Periodontitis
Clinical Characteristics
(4)

A
  • Seen in conjunction
    with other opportunistic
    infections
  • Disease incidence of
    about 20% AIDS cases
  • % may be decreasing with
    ART medications
  • Seen when CD4 count
    < 200 cells/mm3
50
Q

Necrotizing Periodontitis
HIV association
* NP used as a marker for

A

immune deterioration
and a predictor for the diagnosis of AIDS
since it appears with CD4 counts below 200
cells/mm3

51
Q

NP diagnosis to time of death (Glick et al, 1994)
* —% within 18 months
* —% within 24 months

A

60
73

52
Q

Necrotizing Periodontitis
Clinical Symptoms & Signs
(5)

A
  • Appearance of NG
    superimposed over rapid /
    progressive attachment
    and bone loss
  • Necrosis of marginal and
    papillary gingiva
  • Persistent throbbing pain
  • Tooth mobility
  • Lymphadenopathy and
    low-grade fever
53
Q

Necrotizing Periodontitis
Microbiology
Dominant cultivable microbes (% of examined diseased sites)
(6)

A

Candida albicans 70%
Prevotella intermedia 67%
Campylobacter rectus 47%
Actinobacillus actinomyces 28%
Porphyromonas gingivalis 23%
Miscellaneous enteric bacteria

54
Q

Necrotizing Periodontitis
Microbiology
Enteric bacterial spices associated with NP
(5)

A

Enterococcus avium
Enterococcus faecalis
Clostridium difficile
Clostridium clostridiforme
Klebsiella pneumonia

55
Q

Necrotizing Periodontitis
Treatment
(4)

A

Consult patients’ physician:
Non-surgical therapy:
Antibiotics:
Surgical correction may be indicated

56
Q

Consult patients’ physician:
Non-surgical therapy:
Antibiotics:

A

prevent drug interaction

0.12% Chlorhexidine pre/post-treatment rinse
Debridement with hand instruments

Metronidazole 250 mg 4x daily for 7-10 days
Antifungal therapy if indicated

57
Q

Necrotizing Stomatitis
Clinical Characteristics
(3)

A
  • An extension of the
    infection of NP to involve
    interradicular, interseptal
    and crestal bone
  • May be considered as a
    localized severe
    osteomyelitis
  • Occurs with other
    opportunistic infections
58
Q

Necrotizing Stomatitis
Clinical Characteristics
* Seen in less than –%
of AIDS cases
* Seen when CD4 count

  • Seen as NP with areas
    of
A

5
< 50 cells/mm3
exposed necrotic
alveolar bone

59
Q

Necrotizing Stomatitis
Clinical Characteristics
(5)

A
  • Necrosis and ulceration of
    the gingiva extending into
    the alveolar mucosa rapidly
  • Exposure of necrotic bone
    with extension into
    osteomyelitis
  • Tooth mobility
  • Lymphadenopathy and
    fever
  • Bacteremia, septicemia
60
Q

Necrotizing Stomatitis
Microbiology
(3)

A

Candida albicans
Mixed gram negative anaerobic
infection
Miscellaneous enteric bacteria

61
Q

Necrotizing Stomatitis
Treatment
(4)

A

Consult patients’ physician:
Non-surgical therapy:
Antibiotics:
Surgical correction may be indicated

62
Q

Consult patients’ physician:
Non-surgical therapy:
Antibiotics:
Surgical correction may be indicated

A

prevent drug interaction

0.12% Chlorhexidine pre/post-treatment rinse
Debridement to remove oral necrotized tissue
Scaling with hand instruments

Metronidazole 250 mg 4x daily for 7-10 days
Antifungal therapy if indicated

63
Q

The patient reports a history of HIV infection,
and presents the oral lesion diagnosed as
necrotizing periodontitis. Please choose the
most appropriate management.
A. Treatment includes the debridement and 0.12% Chlorhexidine
rinse then prescribe Metronidazole 250 mg 4x daily for 7 days.
B. Treatment includes consulting the physician for drug interaction,
debridement and 0.12% Chlorhexidine rinse, then re-evaluate
for the indication of surgery.
C. Treatment includes the 0.12% Chlorhexidine rinse and leave the
pseudomembrane as the protection layer during debridement,
then prescribe Metronidazole 250 mg 4x daily for 7 days.
D. Treatment includes consulting the physician for drug interaction,
debridement and 0.12% Chlorhexidine rinse, prescribe
Metronidazole 250 mg 4x daily for 7 days then re-evaluate for
the indication of surgery.

A
64
Q

Cancrum Oris (Noma)
(3)

A
  • A rapidly progressive
    often gangrenous
    infection extends from
    mouth to face
  • Affects impoverished
    and malnourished
    children (2-6 years old)
  • In countries in poverty
    (Africa, Asia, South
    America)

Periodontics (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions