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Periodontics I > Necrotizing Periodontal Diseases > Flashcards

Necrotizing Periodontal Diseases Flashcards

1
Q

what are necrotizing periodontal diseases

A

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

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2
Q

what is necrotizing periodontal disease characterized by

A
  • gingival tissue necrosis and ulceration
  • has a sudden onset and can become a chronic condition
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3
Q

what is the nomenclature for necrotizing periodontal disease

A
  • ulceromembranous gingivitis
  • trench mouth
  • vincents gingivostomatitis
  • phagedenic gingivitis
  • fusospirallary periodontitis
  • plaut- vincent stomatitis
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4
Q

what are the stages of necrotizing disease

A
  • stage 1: necrosis of the tip of the inerdental 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 exposing alveolar bone
  • stage 7: necrosis perforates facial skin
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5
Q

necrotizing periodontal disease is mainly seen in:

A

HIV infected individuals and malnourished children

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6
Q

what is the prevalence/incidence of necrotizing periodontal disease in gen pop, military, students, HIV/AIDS

A
  • gen pop: 0.51-3.3%
  • military: 0.19-6.19%
  • students: 0.9-6.7%
  • HIV/AIDS patients: 0-30%
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7
Q

what are the main etiology and risk factors

A
  • microbiology
  • host immune response
  • predisposing factors
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8
Q

what are the main species in necrotizing periodontal disease

A
  • main: spirochetes and fusiform bacteria
  • P. intermedia
  • treponema
  • selenomonas
  • fusobacterium species
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9
Q

what are the specific features in HIV

A
  • candida albicans
  • herpes viruses
  • superinfecting bacterial species
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10
Q

what is the host response that are risk factors for necrotizing periodontal disease

A
  • PMN function: chemotaxis and phagocytosis are impaired
  • immune system: may be related to various levels of nutritional deficiency, fatigue caused by chronic sleep deprivation, alcohol or drug abuse, pyschosocial factors, or systemic diseasew
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11
Q

what are the predisposing factors that are risk factors for necrotizing periodontal disease

A
  • pre-existing systemic disease: leukemia, leukopenia, HIV/AIDS
  • previous hx of NPD
  • inadequate OH
  • malnutrition
  • stress/insufficient sleep
  • smoking/alcohol consumption
  • young age and ethnicity
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12
Q

Why is HIV/AIDS a risk factor for necrotizing periodontal disease

A

-AIDS: marked shift of CD4/CD8 ratio (normal 2:1)
- definition is one of the following
- CD4 count less than 200 cells in a HIV positive patient
- HIV+ patients with more than one opportunistic infection: pulmonary TB, recurrent pneumonia, invasive cervical carcinoma

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13
Q

what are the categories of disease in HIV/AIDS

A
  • normal count: 900-1800
  • preventative therapy: less than or equal to 500
  • infection occurs frequently HIV+ becomes AIDS: 200-500
  • significant changes occur less than or equal to 200
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14
Q

how do you interpret the viral count

A

monitor status of disease, guide therapy, prognosis

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15
Q

how do you interpret the absolute neutrophil count

A

require antibiotic prophylaxis when ANC <500

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16
Q

how should you interpret the platelet count

A

no procedures if below 50,000

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17
Q

what are the oral lesions with HIV/AIDS

A
  • candidiasis
  • viral lesions
  • major aphthous ulcers
  • necrotizing gingivitis
  • linear gingival erythema
  • necrotizing periodontitis
  • neoplasms: non hodkins lymphoma, oral hairy leukoplakia, Kaposi’s sarcoma
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18
Q

what is the histopathology of necrotizing gingivitis lesions

A

the presence of necrotic tissue forming the gray marginal pseudomembrane and an ulcer and accumulation of leukocytes and fibrin replacing the normal epithelium

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19
Q

what is the tissue involved and observation with psuedomembrane

A
  • surface epithelium
  • it is destroyed and replaced by a meshwork of fibrin, necrotic epithelium, PMNs and various types of microorganismswh
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20
Q

what is the tissue involved and the observation with linear erythema

A
  • underlying connective tissue
  • it is hyperemic with numerous engorged capillaries and a dense infiltration of PMNs
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21
Q

what are the 4 zones in histology and describe each

A
  • bacterial zone: contains a mass of bacteria, mainly spirochetes
  • neutrophil rich zone: many leukocytes predominately neutrophils, spirochetes
  • necrotic zone: contains disintegrating tissue cells- spirochetes and fusiforms
  • spirochetal infiltration zone: tissue components infiltrated with spirochetes. no other microorgansims found in this zone
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22
Q

what is the pathophysiology of necrotizing periodontal disease

A
  • conventional periodontal pockets with deep probing depths are not found in NG and NP
  • the necrosis of the JE in NG and NP creates an ulcer that prevents the junctional epithelium migration apically
  • a periodontal pocket cannot form due to this
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23
Q

what is the assessment for necrotizing periodontal diseases

A
  • clinical findings account for dx of NPD
  • microbiological or biopsy assessment can be performed in cases of atypical presentations or non responding cases
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24
Q

what are the primary signs and symptoms of NPD

A
  • gingival necrosis and ulcer in the interdental papila
  • gingival bleeding spontaneously or brushing
  • mild to moderate pain
  • psuedomembrane formation
  • halitosis
  • may have aggressive tissue destruction/bone loss
  • severe gingival recession
  • hypersensitivity
  • suppuration
  • dysgeusia
  • low grade fever
  • lymphadenopathy
25
Q

what are the other common signs and symptoms of NPD

A
  • psuedomembranes
  • halitosis
  • adenopathies
  • fever
26
Q

what are the main signs and symptoms for NPD

A
  • gingival necrosis
  • gingival bleeding
  • pain
27
Q

what are the clinical characteristics of necrotizing gingivitis

A
  • not contagious
  • age onset is generally 15-30 years old
  • strong relationship between onset of disease and level of stress/anxiety
  • responds to antibiotic and non surgical periodontal therapy
  • 75% of patients exhibit a localized defect in neutrophil chemotaxis and/or phagocytosis
28
Q

why does stress cause necrotizing gingivitis

A
  • increased serum cortisol
  • immune system depression
29
Q

what are the clinical signs and symptoms of NG and percentage of prevalence

A
  • necrosis and ulceration in interdental papillae (94-100%)
  • gingival bleeding (95-100%)
  • pain (86-100%)
  • psuedomembrane formation (73-88%)
  • halitosis (84-97%)
  • adenopathy (44-61%)
  • fever (20-39%)
30
Q

what is the microbio of NG

A
  • fusobacterium nucleatum
  • prevotella intermedia
  • treponema spp.
    -spirochetes
31
Q

what is the diff dx for NG

A
  • gingivitis
  • herpetic gingivostomatitis
  • mucous membrane pemphigoid
  • allergic reaction (nickel)
  • mild or grade A/B periodontitis
  • factitial injury
32
Q

what are the keys to differentiate between herpetic gingivostomatitis and NPD

A
  • age
  • body temperature
  • lesion site
  • clinical symptoms
33
Q

what is the etiologyf of NPD and PHG

A
  • NPD: bacteria
  • PHG: herpes simplex virus
34
Q

what is the age of NPD and PHG

A
  • NPD: 15-30 years
  • PHG: frequently children
35
Q

what is the site of NPD and PHG

A
  • NPD: interdental papillae. rarely outside gingiva
  • PHG: gingival and entire oral mucosa
36
Q

what are the symptoms of PHG and NPD

A
  • NPD: ulcerations, necrotic tissue and a yellowish- white plaque. low grade fever
  • PHG: multiple vesicles which disrupt leaving small round fibrin covered ulcerations. fever greater than 38 degrees C
37
Q

what is the duration of NPD and PHG

A
  • NPD: 1-2 days if treated
  • PHG: 1-2 weeks
38
Q

is NPD or PHG contagious

A
  • NPD: no
  • PHG: yes
39
Q

do you get immunity from NPD or PHG

A
  • NPD: no
  • PHG: yes
40
Q

what is the healing of NPD and PHG

A

-NPD: destruction of periodontal tissue remains
- PHG: no permanent destruction

41
Q

describe linear gingival erythema

A
  • prior to other opportunistic infections
  • incidence of about 30-40% of AIDS cases
  • seen when CD4 count is 200-500 cells/mm^3 or less than 200 cells/mm^3
42
Q

what is the microbiology in linear gingival erythema

A
  • fusobacterium nucleatum
  • porphyromonas gingivalis
  • A. actinomycecomitans
  • Treponma spp
  • candida
43
Q

what is the tx for necrotizing gingivitis

A
  • non surgical therapy: improve OH, debridement, 0.12% chlorhexidine pre/post treatment rinse
  • antibiotics: metronidazole 250 mg 3X daily for 7 days ( first choice) OR amoxicillin 500mg 3x daily for 7 days
44
Q

what are the clinical characteristics of necrotizing periodontitis

A
  • seen in conjunction with other opportunistic infections
  • disease incidence of about 20% of AIDS cases- percentage may be decreasing with ART medications
  • seen when CD4 count is below 200cells/mm^3
45
Q

what is the NP association with AIDS

A
  • NP is used as a marker for immune deterioration and a predictor for the diagnosis of AIDS since it appears with CD4 counts below 200 cells/mm^3
  • NP diagnosis to time of death:
  • 60% within 18 months
  • 73% within 24 months
46
Q

what are the clinical signs and symptoms of NP

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
47
Q

what are the dominant cultivable microbes in NP and their percentages

A
  • candida albicans (70%)
  • prevotella intermedia (67%)
  • campylobacter rectus (47%)
  • actinobacillus actinomyces (28%)
  • porphyromonas gingivalis (23%)
  • miscellaneous enteric bacteria
48
Q

what enteric bacteria are associated with NP

A
  • enterococcus avium
  • enterococcus faecalis
  • clostridium difficile
  • clostridium clostridiforme
  • klebsiella pneumonia
49
Q

what is the differential dx for necrotizing periodontitis

A
  • severe or grade C periodontitis
  • uncontrolled/undiagnosed diabetes
  • osteomyelitis, ostenecrosis of the jaw, osteoradionecrosis
  • severe immune suppression, chemotherapy or leukemia
50
Q

what is the treatment for NP

A
  • consult patients physician to prevent drug interactions
  • non surgical: improve OH, debridement with hand instruments, 0.12% chlorhexidine pre/post treatment rinse
  • antibiotics: metronidazole 250mg 4x daily for 7-10 days. antifungal therapy if needed
  • surgical correction may be involved
51
Q

what are the clinical characteristics of necrotizing stomatitis

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
  • seen in less than 5% of AIDS cases
  • seen when CD4 count is below 50 cells/mm^3
  • seen as NP with areas of exposed necrotic alveolar bone
52
Q

what are the clinical signs and symptoms of necrotizing stomatitis

A
  • necrosis and ulceration of the gingiva extending into the alveolar mucosa radpidly
  • exposure of necrotic bone with extension into osteomyelitis
  • tooth mobility
  • lymphadenopathy
  • fever
  • bacteremia, speticemia
53
Q

what is the microbio for necrotizing stomatitis

A
  • candida albicans
  • mixed gram negative anaerobic infection
  • miscellaneous enteric bacteria
54
Q

what is the differential dx for necrotizing stomatitis

A
  • severe or grade C periodontitis
  • uncontrolled/undiagnosed diabetes
  • osteomyelitis, osteonecrosis of the jaw, osteoradionecrosis
  • severe immune suppression, chemotherapy or leukemia
55
Q

what is the tx for necrotizing stomatitis

A
  • consult patients physician to prevent drug interactions
  • non surgical: improve OH, debridement with hand instruments, 0.12% chlorhexidine pre/post treatment rinse
  • antibiotics: metronidazole 250mg 4x daily for 7-10 days. antifungal therapy if needed
  • surgical correction may be involved
56
Q

what are the clinical characteristics of cancrum oris (Noma)

A
  • a rapidly preogressive, often gangrenous infection from the mouth to the face
  • preceded by NP, NP, and NS
  • seen in impoverished and malnourished children 2-6 years old mostly in the poorest countries of africa, asia and south america
  • HIV infected individuals in some regions are affected but not in other regions
57
Q

what is the treatment for cancrum oris

A
  • consult patients physician to prevent drug interaction
  • admit patient to hospital for IV antibiotics, fluids, nutritional supplementation, and supportive medical care (physician)
  • non surgical periodontal therapy is done after patients general condition is stable: debridement with hand instruments. 0.12% chlorhexidine pre/post treatment rinse
58
Q
A

Periodontics I (13 decks)

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