Necrotising Periodontal Diseases
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Questions and Answers

What was the diagnosis made for the patient in January 2006?

  • Acute Necrotising Periodontitis (correct)
  • Chronic Gingivitis
  • Bacterial Meningitis
  • Oral Thrush

    • What significant finding was noted in the clinical presentation of the patient?

  • Extensive dental caries
  • Bilateral cervical lymphadenopathy (correct)
  • Normal CD4 count
  • Healthy gingiva

    • Which medication was included in the drug history for managing the patient's HIV?

  • Acyclovir
  • Metronidazole
  • Valaciclovir (correct)
  • Amoxicillin

    • What condition did the patient experience in 2004, indicative of opportunistic infections associated with HIV?

    <p>Oesophageal candidosis</p> Signup and view all the answers

    What was a significant contributing factor to the patient's likelihood of experiencing Acute Necrotising Periodontitis again?

    <p>Lack of oral hygiene</p> Signup and view all the answers

    What is a characteristic feature of necrotising ulcerative gingivitis?

    <p>Formation of a pseudo-membrane</p> Signup and view all the answers

    Which bacteria is NOT typically involved in necrotising ulcerative gingivitis?

    <p>Streptococcus mutans</p> Signup and view all the answers

    What is NOT a predisposing factor for necrotising periodontal diseases?

    <p>Regular flossing</p> Signup and view all the answers

    Which symptom is most closely associated with necrotising ulcerative gingivitis?

    <p>Marked, distinct halitosis</p> Signup and view all the answers

    What is the primary treatment for necrotising ulcerative gingivitis during its acute phase?

    <p>Debridement</p> Signup and view all the answers

    Which condition is characterized by more extensive necrosis beyond the gingival margin?

    <p>Necrotising ulcerative periodontitis</p> Signup and view all the answers

    Which mouthwash is NOT typically recommended for treating necrotising ulcerative gingivitis?

    <p>Listerine</p> Signup and view all the answers

    Which psychological factor can contribute to poor oral health in patients with necrotising periodontal diseases?

    <p>Anxiety and stress</p> Signup and view all the answers

    What is an additional factor that is linked to the severity of necrotising ulcerative gingivitis?

    <p>Underlying systemic diseases</p> Signup and view all the answers

    What is the key detrimental impact of necrotising periodontal diseases on oral health?

    <p>Rapid tissue destruction</p> Signup and view all the answers

    Study Notes

    Necrotizing Periodontal Diseases

    • Necrotizing periodontal diseases (NIDs) are severe conditions linked to dental biofilm.
    • Prevalence of NIDs is low.
    • They cause rapid tissue destruction.

    GDC Learning Outcomes

    • Describe oral diseases and their role in prevention, diagnosis and treatment.
    • Explain the cause and progression of oral diseases (aetiology and pathogenesis).
    • Recognize psychological and social factors influencing oral health, disease progression, and treatment success.
    • Recognize changes in patient oral health and take action.
    • Recognise and manage patients with acute oral conditions.
    • Ensure appropriate dental team member involvement.

    Intended Learning Outcomes

    • Identify key features of necrotizing periodontal diseases.
    • Determine predisposing factors for necrotizing periodontal diseases.
    • List the signs and symptoms of necrotizing ulcerative gingivitis (NUG).
    • Outline the treatment for NUG.

    Necrotizing Ulcerative Gingivitis (NUG)

    • Acute infection affecting the marginal gingiva.
    • Characterized by a white/grey slough of necrotic tissue.
    • Surrounding tissue is red and inflamed.
    • Necrotic areas start at papillae tips, often presenting as punched-out ulcers.
    • Microorganisms involved include: spirochaetes, Borrelia vincentii, and Fusobacterium.
    • Bacterial composition varies between patients and sites. (Loesche et al 1982)

    Predisposing Factors

    • Pre-existing gingivitis
    • Poor oral hygiene (poor OH)
    • Smoking
    • Stress
    • Poor immune system (common in poorly controlled conditions)

    Signs and Symptoms

    • Ulceration of gingival papillae or margin.
    • Formation of a pseudo-membrane.
    • Pain.
    • Distinct halitosis (bad breath).

    Treatment of NUG

    • Debridement (removal of necrotic tissue), which can be painful.
    • Mouthwashes with chlorhexidine or hydrogen peroxide.
    • After the acute phase, address predisposing risk factors to prevent recurrence.
    • Possible antibiotic therapy with metronidazole.

    Necrotising Ulcerative Periodontitis (NUP)

    • NUP is an extension/progression of NUG.
    • Characterised by necrosis affecting the periodontal ligament and alveolar bone.
    • NUP lesions can be extensive, extending more than 10mm beyond the gingival margin or mucogingival junction.
    • Patients using recreational drugs might exhibit NUP type lesions.
    • Noma (cancrum oris), a severe and often fatal condition, may develop as a complication in some individuals.
    • NUP requires specialist treatment.

    Case Study - Gladys

    • Born December 1988.
    • African origin.
    • Moved to the UK aged 2.
    • Lived with her mother.
    • HIV positive.
    • History of several medical conditions involving the immune system (e.g., Pulmonary TB, various infections) including oral candidosis.
    • 1991 (age 2.8 years): Developmental delay, CD4 count 612, Bilateral parotid enlargement, Bilateral tympanic membrane perforations.
    • Developed conditions throughout the 90s and into the 2000s such as various infections.
    • Severe immunocompromise with a multi-drug resistant virus.
    • Referred to EDH (Eastman Dental Hospital) in January 2006 with worsening gum infection (Acute Necrotizing Periodontitis).
    • Specific medication information was provided (prednisolone, ranitidine, Lamivudine, Didanosine, fluconazole, septrin, azithromycin, ethambutol, ciprofloxacin, valaciclovir, etc).
    • Had significant bilateral cervical lymphadenopathy, marked gingival ulceration of the palatal mucosa (from UL5 to UR5), and marginal inflammation of the lower labial gingivae.

    Management

    • Clinical photographs.
    • Continued medication (including metronidazole).
    • 2% Lignocaine ointment.
    • Mouth rinses (Corsodyl and Difflam).
    • Intensive debridement of affected areas at the School of Hygiene and Therapy from the outset (immediately).
    • Duration of treatment was a week.

    Conclusion

    • NUG is easily recognizable once observed and smelled.
    • NUG usually occurs on top of other health problems.
    • Patients with poor oral hygiene are more susceptible to NUG.
    • NUP is rare; specialized treatment is necessary.

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    Necrotising Periodontal Diseases DHT23 PDF

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