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necrotizing perio dx Flashcards

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1
Q

necrotizing perio dx characterized by:

A

necrosis and
ulceration

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2
Q

necrotizing perio dx onset and duration

A

Sudden onset
and it can become a
“chronic condition”

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3
Q

necrotizing perio dx defined

A

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

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4
Q

nomenclature of necrotizing perio dx over time

A
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5
Q

1989 classification of necrotizning perio dx: stages 1-7

A

staged

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6
Q

1999 classification of necro perio dx

A

4 forms

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7
Q

2017 classification

A
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8
Q

Prevalence/Incidence of necrotizing perio dx in general pop

A

0.5 - 3.3% in general populations

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9
Q

Prevalence/Incidence of necrotizing perio dx in military

A

0.2 - 6.2% in military personnel
* 4%-20.6% when it was close to the end of WW2

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10
Q

Prevalence/Incidence of necrotizing perio dx in students

A

0.9 - 6.7% in students

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11
Q

Prevalence/Incidence of necrotizing perio dx in HIV/AIDS

A

0 - 30 % in HIV/AIDS patients
* 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)

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12
Q

highest prevalence populations for necrotizing perio dx

A

HIV-infected individuals
Malnourished children

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13
Q

etiology/risk factors of necrotizing perio dx: microbial factors

A

Spirochetes and fusiform bacteria
P. intermedia
Treponema
Selenomonas
Fusobacterium species

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14
Q

specific microbio risk factors of HIV pts

A

Candida albicans
Herpes viruses
Superinfecting bacterial species

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15
Q

host determinant risk factors of necrotizing perio dx

A

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

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16
Q

environmental risk factors of necro perio dx

A

Mulnutrition
Stress
Insufficient sleep
Smoking/alcohol consumption
Inadequate oral hygiene

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17
Q

stress effects for necro perio

A
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18
Q

HIV/AIDS

A
  • HIV: Human Immunodeficiency Virus
  • AIDS: Late stage of the HIV infection
  • Marked shift of CD4/CD8 ratio
  • normal ratio is 2:1
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19
Q

AIDS

defined? susceptiable to?

A

Late stage of the HIV infection
* Definition (one of the following)
* CD4 count <200 cells/mm3 in an HIV+ patient
* HIV+ patients with ≥ one opportunistic infection
* - Pulmonary TB
* - Recurrent pneumonia
* - Invasive cervical carcinoma

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20
Q

HIV/AIDS severity based on?

A

Disease severity based on CD4 counts (T-helper cell)

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21
Q

oppurtunistic infections and t cell count of AIDS/HIV
400-500
301-400
201-300
101-200
0-100

A

r

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22
Q

important lab data of necro perio

interpreatation of these?

A
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23
Q

HIV/AIDS
Oral lesions

A
  • Candidiasis
  • Viral lesions
  • Major aphthous ulcers
  • Necrotizing gingivitis
  • Linear gingival erythema
  • Necrotizing periodontitis
  • Neoplasms: Oral hairy leukoplakia, Kaposi’s sarcoma, Non-Hodgkins lymphoma
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24
Q

When to premeditate
HIV/AIDS patients for
invasive procedures?

A

When Absolute Neutrophil Count is less than 500

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25
Necrotizing Gingivitis histopathology
It shows nonspecific acute inflammatory reaction surrounding an ulcer within the stratified squamous epithelium and the gingival connective tissue
26
Necrotizing Periodontitis light microscopy
Identical to a necrotizing gingivitis lesion Except the destruction of the underlying periodontium
27
light microscopy clinical features observed
Pseudomembrane and linear erythema
28
pseudomembrane location and microscopic appearence
Surface epithelium: It is destroyed and replaced by a meshwork of fibrin, necrotic epithelium, PMNs and various types of microorganism.
29
linear erythema location and microscopic observations
Underlying connective tissue: It is hyperemic with numerous engorged capillaries and dense infiltration of PMNs
30
Electron Microscopy: microscopic zones
31
what is seen in this electromicroscopy
Bacterial smear * Spirochetes * Rods
32
phago in electronmicroscopy
* Neutrophil approach the bacterial zone
33
steps to managing necro perio
Assessment Diagnosis Treatment
34
assessing necro perio * Find out? * Clinical findings account for? *atypical presentation or non-responding cases?
* Find out predisposing factors * Clinical findings account for diagnosis of NPD * Microbiological or biopsy assessment in atypical presentation or non-responding cases
35
assessing: possible signs and symptoms of necro perio | primary vs other
36
Signs and Symptoms necro perio dx's * Necrosis where? * Bleeding? * pain? * Pseudomembrane? * breath? * tissue destruction/bone loss? * gingival recession? * sensitivity? * Suppuration? * Dysgeusia? * fever? * Lymph nodes?
* Necrosis and ulcer in the interdental papilla * Bleeding spontaneously or while brushing * Mild to moderate pain * Pseudomembrane formation * Halitosis * May have aggressive tissue destruction/bone loss * Severe gingival recession * Hypersensitivity * Suppuration * Dysgeusia * Low-grade fever * Lymphadenopathy
37
Possible Necrotizing Periodontal Diseases
38
Possible Necrotizing Periodontal Diseases
39
Necrotizing Gingivitis Clinical Characteristics * Contagious? * Age onset? * Strong relationship between?
* Not Contagious * Age onset is generally 15-30 years old * Strong relationship between onset of disease and level of stress/anxiety
40
Necrotizing Gingivitis Clinical Characteristics * Respond to what tx? * 75% patients exhibit localized defects with what immune processes?
* Respond to antibiotic and non-surgical periodontal therapy * 75% patients exhibit a localized defect in neutrophil chemotaxis and/or phagocytosis
41
Necrotizing Gingivitis Clinical Symptoms & Signs
* 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%)
42
Necrotizing Gingivitis: Differential Diagnosis possible
* Gingivitis * Herpetic gingivostomatitis * Mild or grade A/B periodontitis * Facticial injury * Allergic reaction(Nickel) * MMP * Linear gingival erythema
43
Differential Diagnosis: Herpetic Gingivostomatitis | keys to differentiate
* Primary herpetic gingivostomatitis (PHG) is frequently mistaken for NPD. (Klotz 1973) * Keys to differentiate: Age, body temperature, lesion site, clinical symptoms
44
NPD vs PHG
45
Differential Diagnosis: necrotizing gingivits vs HIV association
HIV with: Linear gingival erythema, Intense erythematous marginal gingivitis May have profuse BOP
46
Linear gingival erythema with HIV * Prior to? * Incidence rate? * Seen when CD4 count is?
* Prior to other opportunistic infections * Incidence of about 30-40% of AIDS cases * Seen when CD4 count > 200 cell/mm3
47
Necrotizing Gingivitis non-surgical Treatment
* Improve oral hygiene and debridement * 0.12% Chlorhexidine pre/post-treatment rinse
48
Necrotizing Gingivitis Abx Treatment
* Metronidazole 250 mg 3x daily for 7 days (first choice) * Or Amoxicillin, 500 mg 3x daily for 7 days
49
Necrotizing Periodontitis Clinical Characteristics * Seen in conjunction with? * Disease incidence in AIDS? * % may be decreasing with? * Seen when CD4 count is?
* 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
Necrotizing Periodontitis used as HIV prognostic marker?
* NP used as a marker for immune deterioration and a predictor for the diagnosis of AIDS since it appears with CD4 counts below 200 cells/mm3 * NP diagnosis to time of death (Glick et al, 1994) * 60% within 18 months * 73% within 24 months
51
Necrotizing Periodontitis: Clinical Symptoms & Signs * Appearance of? * Necrosis of? * pain? * mobility? * systemic?
* 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
52
Necrotizing Periodontitis: Microbiology | spp
* Candida albicans 70% * Prevotella intermedia 67% * Campylobacter rectus 47% * Actinobacillus actinomyces 28% * Porphyromonas gingivalis 23% * Miscellaneous enteric bacteria
53
Necrotizing Periodontitis: potential Differential Diagnosis
* Severe or grade C periodontitis * Uncontrolled/Undiagnosed diabetes * Severe immune suppression: chemotherapy or leukemia * ONJ
54
Necrotizing Periodontitis: Treatment, consult?
Consult patients’ physician prevent drug interaction
55
Necrotizing Periodontitis non-surgical Treatment
* 0.12% Chlorhexidine pre/post-treatment rinse * Debridement with hand instruments
56
Necrotizing Periodontitis: Abx Treatment
* Metronidazole 250 mg 4x daily for 7-10 days * Antifungal therapy if indicated
57
Necrotizing Periodontitis Treatment surgery?
Surgical correction may be indicated
58
Necrotizing Stomatitis: Clinical Characteristics * An extension of? * May be considered? * Occurs with other?
* 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
59
Necrotizing Stomatitis: Clinical Characteristics with AIDS * Seen in how many AIDS cases? * Seen when CD4 count is? * Seen as?
* Seen in less than 5% of AIDS cases * Seen when CD4 count < 50 cells/mm3 * Seen as NP with areas of exposed necrotic alveolar bone
60
Necrotizing Stomatitis: Clinical Symptoms & Signs * Necrosis and ulceration? * Exposure of? * mobility? * lymph nodes? * systemic?
* 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
61
Necrotizing Stomatitis Microbiology
* Candida albicans * Mixed gram negative anaerobic infection * Miscellaneous enteric bacteria
62
Necrotizing Stomatitis: potential Differential Diagnosis
63
Necrotizing Stomatitis Treatment with physician
Consult patients’ physicianprevent drug interaction
64
Necrotizing Stomatitis non-surgical Treatment
* 0.12% Chlorhexidine pre/post-treatment rinse * Debridement to remove oral necrotized tissue * Scaling with hand instruments
65
Necrotizing Stomatitis Abx Treatment
* Metronidazole 250 mg 4x daily for 7-10 days * Antifungal therapy if indicated
66
Necrotizing Stomatitis surgical Treatment
Surgical correction
67
Cancrum Oris (Noma) * app/defined? * demo? * where?
* 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)

PERIO I (13 decks)

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