Necrotizing Periodontal Diseases Quiz

Necrotizing Periodontal Diseases

• Necrotizing periodontal diseases (NPD) are severe conditions associated with dental biofilm.
• They are characterized by rapid tissue destruction.
• The prevalence is considered low.

Necrotizing Ulcerative Gingivitis (NUG)

• NUG is an acute infection affecting the marginal gingiva.
• A defining feature is a slough of necrotic tissue (white/gray).
• Adjacent tissues exhibit red inflammation.
• Ulcers form at the papillae tips.
• Microorganisms like spirochetes, Borrelia vincentii, and Fusobacterium are often involved.
• The bacterial mix can differ between patients and sites.

Predisposing Factors for NPD

• Pre-existing gingivitis
• Poor oral hygiene (OH)
• Smoking
• Stress
• Poor immune system (often associated with poorly controlled conditions)

Signs and Symptoms of NUG

• Ulceration of papillae tips or gingival margins
• Formation of a pseudo-membrane
• Pain
• Marked halitosis (bad breath)

Treatment for NUG

• Debridement: Initially, removal of necrotic tissue (may be painful)
• Mouthwashes: Chlorhexidine or hydrogen peroxide-based rinses
• Antibiotics: Metronidazole may be used during the acute phase
• Managing Predisposing Factors: Addressing factors contributing to the recurrence of the disease

Necrotizing Ulcerative Periodontitis (NUP)

• NUP is an extension/progression of NUG.
• Necrosis affects the periodontal ligament and alveolar bone.
• NUP can be seen in patients using oral recreational drugs.
• Some cases of NUP develop into a severe form, also called Noma (cancrum oris).

Case Study: Gladys

• Born in December 1988 (African origin)
• Moved to the UK at age 2.
• Lived with her mother
• Diagnosed with HIV infection, acquired perinatally.
• Multi-drug resistant virus, significant immune suppression issues.
• Steroid-responsive multi-system inflammatory disorder
• Gastrostomy
• Reported worsening gum infection since early December 2006 (age 18)

HIV Disease Presentation in Gladys

• 1991 (age 2.8 years): Developmental delay, CD4 count 612 (9%), Pulmonary TB, oral candidosis, bilateral parotid enlargement, and bilateral tympanic membrane perforations.
• Additional Clinical Progression Points: Varicella-zoster infection (1996), Recurrent zoster infection (1998), Recurrent staphylococcal skin abscesses (2000), Acne vulgaris (2001), Persistent cervical lymphadenitis (2004), Oesophageal candidiasis (2004), Kukuchi lymphadenitis, and necrotizing ulcerative periodontitis (2005).

Drug History for Gladys

• Prednisolone 20 mg twice-daily
• Lamivudine 300 mg once daily
• Ranitidine 10 ml once daily
• HAART (Highly Active Antiretroviral Therapy): Didanosine 250 mg once daily, Fluconazole 250 mg once daily, Septrin 960 mg three times a week, Azithromycin 500 mg once daily, Ethambutol 300 mg once daily, Ciprofloxacin 750 mg once daily for a week, and Valaciclovir 1 g three times a day once daily for a week.

Clinical Presentation of Gladys

• Bilateral cervical lymphadenopathy
• Marked gingival ulceration of the palatal mucosa (UL5 to UR5).
• Marginal inflammation of inferior labial gingival tissue.
• Diagnosis: Acute Necrotizing Periodontitis

Management of Gladys

• Clinical photographs
• Continue medication.
• Metronidazole 400 mg three times a day for one week.
• 2% Lignocaine ointment
• Corsodyl and Difflam mouth rinses
• Intensive debridement of affected areas immediately (at School of Hygiene and Therapy).

Case Study Conclusion Regarding Gladys

• NUG is a distinct and easily recognized condition.
• It commonly occurs over pre-existing disease.
• OH must be immaculate to minimize recurrence.
• NUP is uncommon and requires specialized treatment.

Test your knowledge on necrotizing periodontal diseases, including Necrotizing Ulcerative Gingivitis (NUG). This quiz covers characteristics, symptoms, predisposing factors, and treatment options associated with these severe oral conditions. Understand the microbial involvement and the impact of personal health on periodontal health.