Necrotising Periodontal disease Flashcards
What are the main features of necrotising periodontal disease?
Pain
Bleeding gums
Ulceration
Necrosis of inter-dental papilla - “punched out” appearance
What is the difference between necrotising: gingivitis, periodontitis and stomatitis?
Gingivitis - when only the gingival tissues are affected
Periodontitis - when necrosis progresses into the periodontal ligament and alveolar bone, leading to attachment loss.
Stomatitis - when necrosis progresses to deeper tissues beyond the mucogingival line, including lip or cheek mucosa, tongue etc.
What conditions are more likely to give rise to necrotising stomatitis?
Severely immunocompromised patients.
Mostly in malnutrition and HIV infections.
What is cancrum oris?
Necrotising and destructive infection of the mouth and face - not strictly a periodontal disease.
Mainly in malnourished children in developing countries.
Where are lesions first seen in necrotising, ulcerative gingivitis?
Inter-proximally in mandibular anterior region
Why are ulcerations often associated with deep pockets?
Gingival necrosis coincides with a loss of crestal alveolar bone.
What flora is constant in NPD?
Fusobacterium sp
Prevotella intermedia
What are risk factors for NPD in developed countries?
Psychological stress
Sleep deprivation
Poor OH
Smoking
Poor diet/ malnutrition
Immunosuppression (HIV infection and leukaemia)
What is the main risk factor for NPD in developing countries?
Malnourished children
What is the first stage of treatment of the acute phase?
Careful Superficial debridement daily, for as long as the acute phase lasts - usually 2-4 days.
Use chlorhexidine-based mouth-rinse twice daily, instead of mechanical OHI as this would be painful
What is the treatment for when patient does not respond to superficial debridement?
Metronidazole 400mg
What is treatment of the chronic condition (once the acute phase has been controlled)?
Professional prophylaxis
AND/ OR
scaling and root planing.
Also evaluate and control pre-disposing factors.
How can you treat resultant gingival craters from the disease?
Gingivectomy and/ or gingivoplasty procedures for superficial craters
Periodontal flap or regenerative surgery for deep craters
What are the stages of treatment of NPD?
OHI
Gentle PMPR over a series of appointments
Chlorhexidine mouth-rinse
Prescribe anti-biotics if risk of spreading infection or systemic involvement
What does the occurrence of NPD in systemically healthy individuals without any pre-disposing individuals suggest?
Suggests they have a HIV infection and should be screened for it.
