WK 9: Perio & Acute Gingival Lesions

Question 1

Define Necrotizing gingivitis

Answer 1

A microbial disease of the gingiva in a n impaired host response characterized by necrosis and sloughing of the gingival tissue

Question 2

what are the 3 clinical forms of Necrotizing Gingivitis

Answer 2

1. Acute: most common
2. Subacute: milde and more persistent form
3. recurrent: Periods of revision and exacerbation.

Question 3

List the predisposing factors for Necrotizing gingivitis

Answer 3

HIV
Immune suppression
poor nutrition (malnourishment)
tobacco
physiological stress

Question 4

Describe oral symptoms or Necrotizing gingivitis

Answer 4

Extreme sensitivity to touch
constant radiating pain( made worse while eating)
metallic foul taste
pasty saliva.

Question 5

Describe Clinical finding of Necrotizing gingivitis

Answer 5

Necrosis/Ulcer in Interdental papilla
gingival bleeding
pain
halitosis
pseudomembrane formation

Question 6

What are the extra oral signs and symptoms of NG

Answer 6

Local Lymphadenopathy
Elevation in temperature

Severe cases
fever
high pulse rate
loss of appetite

Question 7

Describe NG management

Answer 7

Gentle removal of placque and necrosis debris

Irrigation and rinse with Hydrogen peroxide 3%/ (5ml H20 + 5ml H2O2) 2x daily

Metronidazole 400mg, Orally Every 12hr, 3-5 days

analgesics : paracetamol, Ibuprofen

No smoking and OHI

Review patient 48-72hrs

periodontal examination

Thorough debridement when possible

no response= refer

Question 8

Describe differences and when Necrotizing periodontitis can occur

Answer 8

In severely immune compromised patients Bone Sequestra can occur

Occurs due to >1 episodes of necrotizing gingivitis

OR

Occurs due to necrotizing gingivitis @ site previously affected by periodontitis

Question 9

What is necrotizing stomatitis

Answer 9

Defined by the presence of soft tissue necrosis that extends beyond the gingiva with bone denudation (erosion) and formation of bone sequestrum.

Occurs in severely systemically compromised patients

Question 10

what are other names for Noma (cancrumoris)

Answer 10

Necrotizing ulcerative stomatitis
gangrenous stomatitis
cancrum oris

Question 11

Describe early clinical features of Primary hepatic gingivostomatitis

Answer 11

Diffuse (pus)
erythematous (red skin)
shiny involvement of Gingiva and adjacent oral mucosa
oedema
gingival bleeding

Question 12

What occurs within 24 hours of infection with herpes

Answer 12

Vessicles rupture to form painful small ulcers, with a red elevated margin and depressed yellow central portion

Question 13

What is management for herpes

Answer 13

DELAY ELECTIVE SURGIES
Antiviral medication
- Famciclovir 1500mg
-single dose
Give at sign of recurrence

Question 14

Describe pericoronitis

Answer 14

Inflammation of the gingiva in relation to the crown of an incompletely erupted tooth

Question 15

What is the most common site of pericoronitis

Answer 15

Most common site= impacted 3rd molar.

Space between the crown and overlying gingiva flap accumulates debris

Question 16

clinical features of PCoronitis

Answer 16

Red swollen,

Radiating pain to ear, throat and floor of mouth

Foul taste

inability to close jaw

Trismus

fever

malaise

Question 17

Describe the issue with the spread of infection and Pericorononitis with everyday function of the oral cavity.

Answer 17

Can spread posteriorly into the orophrangeal area and medially to the base of the tongue making it difficult to swallow.

Question 18

Describe management strategies for PC

Answer 18

Cleaning the region (debridement)
antibiotics (systemic signs)
Operculectomy or Exo

Question 19

Describe Periodontal Abscess

Answer 19

Acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus.

Question 20

In what 2 types of patients can peridontal abscess occur

Answer 20

Those with a previous Perio pocket (periodontitis patient)

Those without a pre-existing periodontal pocket (non periodontal patient)

Question 21

What are the common causes of Periodontal abscess

Answer 21

1. Periodontal patients:
   - Scaling, root planing, surgical Periodontal treatment
2. Non Periodontal Patient:
   - Foreign bodies, harmful habits, orthodontic factors, gingival enlargement, alteration to root surface

Question 22

Clinical features of a PA

Answer 22

Presence of generalized Perio with pocketing and bone loss

tooth is vital

overlying gingival erythematous

Tender & swollen

painful @ times (eating)

pus discharge via perio pocket

cervical lymphadenopathy

Question 23

management of an abccess

Answer 23

drainage through sulcus
irrigation of accessed pocket
removal of foreign bodies
debreidgement of soft tissue wall
oral hygiene instructions
antibiotics

Question 24

What are the contents of an abscess

Answer 24

bacteria, bacterial products,

inflammatory cells,

tissue breakdown products

serum

Question 25

Get ready for Staging and grading of perio

Answer 25

Take a deep breath you got this.

Question 26

Describe the 3 forms of periodontal health.

Answer 26

1. periodontal health A) clinical gingival health on intact periodontium B) clinical gingival health on a reduced periodontium - Stable perio patient - non perio patient with recession 2. Gingivitis a) associated with direct biofilm alone b) mediated by systemic or local risk factors c) Drug influenced gingival enlargement - Ex: phenytoin induced gingival hyperplasia 3. Gingival diseases (non biofilm induced) - Genetic development disorders - specific infections - Inflammatory immune conditions - reactive processes - neoplasms traumatic lesions

Question 27

What neuropeptide/ neurotransmitter is a key bio marker for Gingivitis

Answer 27

Substance P

Question 28

What are 3 gingivitis modifying factors

Answer 28

Biofilm associated Systemic ( sex hormones, smoking) drug influenced

Question 29

what are the 3 types of periodontitis

Answer 29

1. necrotizing periodontitis 2. periodontitis due to systemic diseases 3. periodontitis

Question 30

What are the primary features of perio

Answer 30

Loss of periodontal tissue support manifested as clinical attachment loss radiographic bone loss Pocketing gingival bleeding

Question 31

What are the requirements for a periodontal case

Answer 31

1. Interdental clinical attachment loss (CAL) is detectable in >=2 non adjacent teeth 2. buccal or oral CAL >= 3mm with pocketing >= 3mm is detectable in >=2 teeth

Question 32

What are 5 causes for Non Perio Clinical attachment Loss

Answer 32

Gingival recession of traumatic origin dental caries extending to cervical area of tooth distal CAL of 2nd molar due to malpostion or extraction of 3rd molar endodontics lesion draining through the marginal periodontitis vertical root fracture

Question 33

What is required to differentiate between stable, remission and currently unstable periodontal status

Answer 33

Question 34

what are differential periodontal diagnosis for periodontitis that need to be ruled out.

Answer 34

gingivitis vertical root fracture cervical caries

Question 35

Describe stage 1 Periodontitis

Answer 35

Question 36

describe stage 2 periodontitis

Answer 36

Question 37

describe stage 3 periodontitis

Answer 37

Question 38

describe stage 4 periodontitis

Answer 38