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Year 2 Integrated theory > Necrotising periodontitis > Flashcards

Necrotising periodontitis Flashcards

1
Q

Describe the terms necrotising gingivitis, necrotising periodontitis and necrotising stomatitis

A
  • The three necrotizing diseases appear to represent various stages of the same disease process
  • A distinction between the different manifestations has not always been made in the literature
  • Hence, necrotizing periodontal disease is an umbrella term for the diseases.
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2
Q

State the synonyms for necrotising gingivitis, necrotising periodontitis and necrotising stomatitis

A

Necrotising gingivitis:
• Trench mouth
• ANUG/ NUG

Necrotising periodontitis:
• Necrotising Ulcerative Periodontitis (NUP)

Necrotising stomatitis:
• NOMA
• Gangrenous stomatitis

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3
Q

State the microflora involved in the pathogenesis of necrotising periodontal diseases

A
  • Treponema spp.
  • Selenomonas spp.
  • Fusobacterium spp.
  • Prevotella intermedia
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4
Q

State the causes of necrotising periodontal diseases (general) (5)

A 
Caused by bacterial infection in patients with specific underlying risk factors: 
• Poor oral hygiene
• Smoking
• Stress
• Poor nutrition
• Compromised immune status [e.g., HIV])
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5
Q

Explain why necrotising periodontal diseases are important and the use of the descriptor term ‘acute’

A
  • Although the prevalence of necrotizing periodontal diseases (NPD) is low, it’s important because it is a severe condition associated with dental biofilm which causes rapid destruction
  • Although the necrotizing diseases often run an acute rapidly destructive course, the term acute has not been included in the diagnoses since 1999.
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6
Q

Does ulcerative gingivitis cause loss of periodontal attachment?

A

• The term “gingivitis” is used for lesions only involving gingival tissue and characterized by no loss of periodontal attachment.

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7
Q

Describe the clinical features of Necrotizing Gingivitis

A
  • Small, grey, ulcerative lesions at tips of interdental papillae
  • Spreads to gingival margins to create cratered lesions
  • Greyish- white pseudomembrane may cover affected areas
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8
Q

Describe the signs (3) and symptoms (4) of Necrotizing Gingivitis

A

Signs:
• Spontaneous gingival bleeding
• Burning sensation in mouth
• Heavy plaque deposits

Can spread to underlying periodontal tissues

Symptoms:
• lymphadenopathy (lymph nodes abnormal in size, consistency and number)
• Fever
• foul mouth odour
• malaise
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9
Q

Describe the microbiology of Necrotizing Gingivitis

A 
Spirochetes 
• Fusobacterium
• Prevotella intermedia
• Treponema
• Selenomonas
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10
Q

Describe the clinical features of Necrotizing Periodontitis (5)

A
  • Ulceration of the gingival margin
  • Fibrin deposits at sites with characteristically decapitated gingival papillae
  • Extensive necrosis of gingiva
  • Exposure of the marginal alveolar bone and destruction of the bone
  • Extensive attachment loss (doesn’t necessarily cause deep perio pockets)
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11
Q

Describe the signs and symptoms of Necrotizing Periodontitis (2)

A

Signs:
• Severe pain
• 50% of sites show spontaneous bleeding

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12
Q

Describe the microbiology of Necrotizing Periodontitis

A 
○ Spirochetes-Borellia vincentii
○ Prevtella intermedia
○ Treponema species
○ Selenomonas species
○ Fusobacterium species
○ Vincent vicella
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13
Q

Understand when the three terms are used in diagnosis

A

Necrotising gingivitis:
• Used for lesions only involving gingival tissue and characterized by no loss of periodontal attachment

Necrotising periodontitis:
• Characterised by loss of attachment

Necrotising stomatitis:
• Ulcers extend 1cm from the gingival margin. Including tissue beyond the mucogingival junction

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14
Q

Discuss why necrotising periodontitis is considered a separate disease entity from periodontitis (4)

A
  • It has a distinct pathophysiology characterized by prominent bacterial invasion and ulceration of epithelium
  • Involves rapid and excessive destruction of the marginal soft tissue resulting in soft and hard tissue defects
  • Has prominent symptoms
  • Rapid resolution in response to specific antimicrobial treatment
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15
Q

Discuss the causes/ risk factors for Necrotizing Gingivitis (12)

A
  • Related to psychological stress & systemic disease
  • Stress-related epinephrine may cause localized ischemia, predisposing gingiva to Necrotizing Gingivitis
  • Corticosteroids may alter lymphocyte ratios and cause decreased neutrophil chemotaxis and phagocytic response
  • Immunocompromised status (E.g. AIDS & infectious mononucleosis)
  • Poor eating habits of young adults (college students); low protein intake
  • Caucasian background
  • Local trauma
  • Inadequate sleep
  • Recent illness
  • Poor oral hygiene
  • Alcohol use
  • Smoking
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16
Q

Discuss the risk factors for Necrotizing Periodontitis (5)

A
  • Immunosuppression
  • Malnutrition
  • Following necrotising gingivitis
  • Patients younger than those who experience normal periodontitis
  • May present in area of pre-existing periodontitis or as sequela to Necrotizing Gingivitis
17
Q

Discuss the appropriate treatment for Necrotizing Gingivitis

  • First appointment
  • 2nd appointment
  • 3rd appointment
  • Post treatment/ revaluation
A

1st Appointment-
• Supra gingival scale only
• OHI
• Removal of bacteria
• Chlorhexidine rinses, warm saltwater or diluted hydrogen peroxide
• Antibiotics are useful adjunct (metronidazole)

2nd appointment – (1-2 days after)
• Removal of bacteria through debridement/ scaling but under LA

3nd appointment – (5 days after the 2nd visit)
• Debridement but under LA
• OHE

Post-treatment: Revaluation (1 month)
• Oral hygiene instructions / education
• Identification and resolution of predisposing factors
• Supportive therapy (E.g. rest, nutritious diet, appropriate fluid intake)

18
Q

Discuss the prognosis for Necrotizing Gingivitis

A

• Quick resolution after removal of bacterial challenge

19
Q

Discuss the appropriate treatment for Necrotizing Periodontitis. Mention:

  • Initial treatment goals
  • Considerations for the HIV patient
  • Post- treatment
A

Initial treatment
• Remove bacteria
• Mechanical debridement
• 5 mL Nystatin rinse for HIV-positive patients
• Given LA or topical with NSAIDs
• Systemic antibiotics
• Removal of underlying influence (E.g. immunosuppression, malnutrition)

Post-treatment:
• Oral hygiene instructions / education
• Saline rinses can help to speed resolution
• Oral rinses with a hydrogen peroxide 3% solution may help
• Chlorhexidine 0.12% oral rinse 15 mL

20
Q

Discuss the prognosis for Necrotizing Periodontitis

A
  • Responds well to treatment

* However, loss of attachment and alveolar bone

Year 2 Integrated theory (15 decks)

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