Podcast
Questions and Answers
What characterizes necrotising ulcerative gingivitis?
What characterizes necrotising ulcerative gingivitis?
Which of the following is a predisposing factor for necrotising periodontal diseases?
Which of the following is a predisposing factor for necrotising periodontal diseases?
Which type of bacteria is primarily associated with necrotising ulcerative gingivitis?
Which type of bacteria is primarily associated with necrotising ulcerative gingivitis?
Which symptom is most notably experienced by patients with necrotising ulcerative gingivitis?
Which symptom is most notably experienced by patients with necrotising ulcerative gingivitis?
Signup and view all the answers
What is a recommended treatment option for necrotising ulcerative gingivitis after the acute phase?
What is a recommended treatment option for necrotising ulcerative gingivitis after the acute phase?
Signup and view all the answers
What is the most common presentation of tissue loss in necrotising ulcerative gingivitis?
What is the most common presentation of tissue loss in necrotising ulcerative gingivitis?
Signup and view all the answers
What is necrotising ulcerative periodontitis primarily associated with?
What is necrotising ulcerative periodontitis primarily associated with?
Signup and view all the answers
In what scenario can necrotising stomatitis occur following necrotising ulcerative periodontitis?
In what scenario can necrotising stomatitis occur following necrotising ulcerative periodontitis?
Signup and view all the answers
Which psychological factor could contribute to poor oral health?
Which psychological factor could contribute to poor oral health?
Signup and view all the answers
What was the initial diagnosis for the patient when referred to the EDH in January 2006?
What was the initial diagnosis for the patient when referred to the EDH in January 2006?
Signup and view all the answers
Which infection did the patient experience in 1996?
Which infection did the patient experience in 1996?
Signup and view all the answers
Which medication was added to the patient's treatment for Acute Necrotizing Periodontitis?
Which medication was added to the patient's treatment for Acute Necrotizing Periodontitis?
Signup and view all the answers
What significant finding was noted during the clinical presentation in January 2006?
What significant finding was noted during the clinical presentation in January 2006?
Signup and view all the answers
Which condition is characterized by inflammation of the lower labial gingivae?
Which condition is characterized by inflammation of the lower labial gingivae?
Signup and view all the answers
What type of HIV associated disease is mentioned as having a distinct smell that is unforgettable?
What type of HIV associated disease is mentioned as having a distinct smell that is unforgettable?
Signup and view all the answers
What form of HIV transmission was indicated for the patient?
What form of HIV transmission was indicated for the patient?
Signup and view all the answers
What is the primary management step proposed for the patient's gingival condition?
What is the primary management step proposed for the patient's gingival condition?
Signup and view all the answers
What was the CD4 count observed in the patient in 1991?
What was the CD4 count observed in the patient in 1991?
Signup and view all the answers
What is indicated as a necessary condition for preventing recurrence of Necrotizing Ulcerative Gingivitis?
What is indicated as a necessary condition for preventing recurrence of Necrotizing Ulcerative Gingivitis?
Signup and view all the answers
Study Notes
Necrotizing Periodontal Diseases
- Necrotizing periodontal diseases (NPeD) are a severe, but rare, group of oral conditions linked to severe and rapid tissue destruction.
- NPeD are characterized by an acute infection affecting the marginal gingiva.
- They are typically associated with dental biofilm.
- Necrosis of the periodontal ligament and alveolar bone is a key feature.
- A characteristic feature is a white/grey slough of necrotic tissue.
- Adjacent inflamed tissue is usually a red color.
- Ulcers are typically punched-out at papillae tips.
Learning Outcomes
- Describe oral diseases and their role in prevention, diagnosis, and treatment.
- Explain the etiology and pathogenesis of oral diseases.
- Recognize psychological and sociological factors that affect oral health, disease progression, and treatment success.
- Recognize and address changes in patient-reported oral health.
- Manage patients with acute oral conditions properly, involving relevant team members.
- List main features of necrotizing periodontal diseases.
- Identify predisposing factors for necrotizing periodontal diseases.
- Recognize signs and symptoms of necrotizing ulcerative gingivitis.
- Describe treatments for necrotizing ulcerative gingivitis (NUG).
Predisposing Factors for NPeD
- Pre-existing gingivitis
- Poor oral hygiene
- Smoking
- Stress
- Poor immune system (common in poorly managed HIV patients)
Necrotizing Ulcerative Gingivitis (NUG)
- Acute infection, characterized by necrotic tissue sloughing.
- Affects marginal gingiva.
- Tissue appears as a white/grey slough of necrotic tissue.
- Adjacent tissues are inflamed and red.
- Necrotic areas start at papillae tips – forming punched-out ulcers.
- Bacteria involved include spirochaetes, Borrelia vincentii, and Fusobacterium species.
- Bacterial mix varies between patients and sites.
Signs and Symptoms of NUG
- Ulceration of gingival papillae or marginal gingiva
- Formation of a pseudo-membrane
- Pain
- Marked, distinct halitosis (bad breath)
Treatment of NUG
- Debridement (may be painful)
- Mouthwashes (e.g., chlorhexidine or hydrogen peroxide)
- Possible antibiotic therapy (e.g., metronidazole)
- Address predisposing factors to reduce recurrence.
Necrotizing Ulcerative Periodontitis (NUP)
- Thought to be an extension or progression of NUG.
- Characterized by necrosis of the periodontal ligament and alveolar bone.
- Necrotizing stomatitis extends beyond 10mm.
- NUP may be seen in patients using oral recreational drugs (potentially).
- Potentially linked to Noma (cancrum oris) in specific regions.
Case Study: Gladys
- Born December 1988, moved to UK at age 2.
- African origin
- Lived with "Mum."
- HIV diagnosis at 2.8 years; CD4 count 612 (9%).
- Developmental delay, Pulmonary TB, oral candidosis, bilateral parotid enlargement, and bilateral tympanic membrane perforations.
- Various infections, such as varicella-zoster infection, recurrent zoster infection, recurrent staphylococcal skin abscesses.
- Persistent cervical lymphadenitis, esophageal candidiasis, necrotizing ulcerative periodontitis.
Clinical Progression of HIV in Gladys
- Detailed timeline of infections after initial HIV diagnosis. (e.g., 1996 Varicella-zoster infection, 1998 Recurrent zoster infection)
Initial Referral to EDH
- January 2006, 18 years old
- Perinatally acquired HIV infection
- Multi-drug resistant virus
- Severe immunodeficiency, with no peripheral CD4 count.
- Steroid-responsive multi-system inflammatory disorder
- Gastrostomy
- Worsening gum infection since early December.
Drug History
- Detailed list of medications used (e.g., Prednisolone 20mg bd, Ranitidine 10mls od).
Clinical Presentation (Gladys)
- Bilateral cervical lymphadenopathy
- Marked gingival ulceration of the palatal mucosa (UL5 to UR5).
- Marginal inflammation of the lower labial gingivae.
- Diagnosis: Acute Necrotizing Periodontitis
Management (Gladys)
- Clinical photographs
- Continue pre-existing medications (including HAART).
- Metronidazole 400mg tds for 1 week
- 2% Lignocaine ointment
- Corsodyl and Difflam mouth rinses
- Intensive debridement of affected areas (started immediately).
Conclusion
- NUG is highly distinctive—once seen and smelled, it won't be forgotten.
- Always occurs on a base of pre-existing disease.
- Patients are likely to have recurrent episodes if oral hygiene isn’t impeccable.
- NUP is rare and requires specialized treatment.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Explore the complexities of necrotizing periodontal diseases (NPeD), a severe group of oral conditions characterized by acute infections and rapid tissue destruction. This quiz highlights the etiology, pathogenesis, and management strategies related to NPeD, as well as the psychological factors influencing oral health care. Test your knowledge on diagnosis, prevention, and treatment practices.
