Necrotising Periodontal Diseases DHT23 PDF

Necrotising Periodontal Diseases Deborah Hemington Oral and Dental Science GDC Learning Outcomes 1.1.2 Describe oral diseases and their relevance to prevention, diagnosis and treatment 1.1.4 Explain the aetiology and pathogenesis of oral disease 1.1.11 Recognise psychological and sociolo...

Necrotising Periodontal Diseases Deborah Hemington Oral and Dental Science GDC Learning Outcomes 1.1.2 Describe oral diseases and their relevance to prevention, diagnosis and treatment 1.1.4 Explain the aetiology and pathogenesis of oral disease 1.1.11 Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases and the success of treatment 1.2.3 Recognise the significance of changes in the patient’s reported oral health status and take appropriate action 1.9.1 Recognise and manage patients with acute oral conditions ensuring involvement of appropriate dental team members Intended Learning Outcomes By the end of the session, you will be able to: List the main features of the necrotising periodontal diseases Describe the predisposing factors for the necrotising periodontal diseases List the signs and symptoms of necrotising ulcerative gingivitis Describe the treatment for NUG. Necrotising Periodontal Diseases Prevalence is Great low importance Represent the most severe Leads to very conditions rapid tissue associated with destruction dental biofilm Necrotising Ulcerative Gingivitis Acute infection Affects marginal gingiva Characterised by white/grey slough of necrotic tissue Adjacent area of red inflamed tissue Necrotic area starts at papillae tips – punched out ulcers Bacteria involved – spirochaetes – Borrelia vincenti - Fusobacterium Bacterial mix varies from patient to patient and site to site ( Loesche et al 1982)  Predisposing Factors 1 Pre existing gingivitis 2 Poor OH 3 Smoking 4 Stress Poor immune system 5 (prevalent in poorly controlled Signs and Symptoms Ulceration of the papillae tips or gingival margin Formation of a pseudo- membrane Pain Marked, distinct halitosis Treatment of NUG 0 Debridement (this After acute phase, 0 may be painful) address the 1 predisposing factors 4 to minimise recurrence 0 Mouthwashes Possible antibiotic 0 (Chlorhexidine or 2 hydrogen peroxide therapy – metronidazole 3 based) Necrotising Ulcerative Periodontitis Necrotising stomatitis – Characterised extends more Is thought to by necrosis of than 10mm Noma be an the NUP type beyond gingival ( cancrum oris extension/prog periodontal lesions may margin or in Africa) may ression of NG ligament and be seen in mucogingival follow on from alveolar bone junction patients NUP and using oral necrotising recreational stomatitis in drugs developing parts of the world Case study in Necrotising Periodontitis Gladys Born December 1988 African origin Moved to the UK aged 2 years Lived with “Mum”. Presentation of HIV disease 1991 (Age - 2.8 years) CD4 count 612 (9%) Developmental delay Pulmonary TB Oral candidosis Bilateral parotid enlargement Bilateral tympanic membrane perforations Clinical progression 1996 Varicella-zoster infection 1998 Recurrent zoster infection 2000 Recurrent staphylococcal skin abscesses 2001 Acne vulgaris Persistent cervical lymphadenitis 2004Oesophageal candidosis Kukuchi lymphadenitis 2005Necrotizing ulcerative periodontitis Initial referral to EDH January 2006 18 years old Perinatally acquired HIV infection Multi-drug resistant virus Severe immuno suppression with no peripheral CD4 count Steroid responsive multi-system inflammatory disorder Gastrostomy “Worsening gum infection” since early December. Drug history 1. Prednisolone 20mg bd 2. Ranitidine 10mls od 3. Lamivudine 300mg od HAART 4. Didanosine 250mg od 5. Fluconazole 250mg od 6. Septrin 960mg 3 times a week 7. Azithromycin 500mg od 8. Ethambutol 300mg od 9. Ciprofloxacin 750mg for 1 week 10.Valaciclovir 1g tds for 1 week. Clinical presentation Bilateral cervical lymphadenopathy Marked gingival ulceration of the palatal mucosa from UL5 to UR5 Marginal inflammation of the lower labial gingivae Diagnosis: Acute Necrotising Periodontitis Image credit: Oral Med dept, EDH Image credit: Oral Med dept, EDH Image credit: Oral Med dept, EDH Management Clinical photographs Continue medication Plus Metronidazole 400mgs tds for 1 week 2% Lignocaine ointment Corsodyl and Difflam mouth rinses Intensive debridement of affected areas at School of Hygiene and Therapy starting immediately. Image credit: Oral Med dept, EDH  Gladys 28.12.88 - 26.01.09 Conclusion NUG is very distinctive, once seen and smelt – never forgotten! Always occurs superimposed on pre-existing disease Patients are likely to experience it again if OH not immaculate. NUP is rare & needs specialist treatment. Thank you