Necrotising Periodontal Diseases GN PDF

Necro&sing Periodontal Diseases Deborah Hemington Oral and Dental Science GDC Learning Outcomes 1.1.2 Describe oral diseases and their relevance to preven5on, diagnosis and treatment 1.1.4 Explain the ae5ology and pathogenesis of oral disease 1.1.11 Recognise psychological and sociologic...

Necro&sing Periodontal Diseases Deborah Hemington Oral and Dental Science GDC Learning Outcomes 1.1.2 Describe oral diseases and their relevance to preven5on, diagnosis and treatment 1.1.4 Explain the ae5ology 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 signiAcance of changes in the pa5ent’s reported oral health status and take appropriate ac5on 1.9.1 Recognise and manage pa5ents with acute oral condi5ons 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 necro5sing periodontal diseases Describe the predisposing factors for the necro5sing periodontal diseases List the signs and symptoms of necro5sing ulcera5ve gingivi5s Describe the treatment for NUG. Necro&sing Periodontal Diseases Prevalence is low Great importance Represent the most severe condi&ons Leads to very rapid associated with &ssue destruc&on dental bioAlm Necro&sing Ulcera&ve Gingivi&s Used to be known as ANUG - A has been dropped Now - NUG Acute infec5on AMects marginal gingiva Characterised by white/grey slough of necro5c 5ssue Adjacent area of red inQamed 5ssue Necro5c area starts at papillae 5ps – punched out ulcers Nothing else looks like it Bacteria involved – spirochaetes – Borrelia vincen5 t Mainly - Fusobacterium Bacterial mix varies from pa5ent to pa5ent and site to site ( Loesche et al 1982) Predisposing Factors ALWAYS happens with gingivitis - never in healthy mouth 1 Pre exis5ng gingivi5s Very painful so usually worse OH than usually 2 Poor OH 3 Smoking 4 Stress Poor immune system (prevalent in 5 poorly controlled HIV pa5ents) Signs and Symptoms Ulcera5on of the papillae 5ps or gingival margin Forma5on of a pseudo-membrane ↳ Greyish slough Pain Marked, dis5nct halitosis Patient may feel unwell and have lymph node involvement Treatment of NUG Scaring of interdental papillae, remains as plaque retentive area. Debridement (this may be A_er acute phase, address 01 painful) Use local anaesthetic the predisposing factors to 04 Power driven scalers very useful minimise recurrence Peroxyl generally Systemic involvement Oxidising agent Mouthwashes 02 (Chlorhexidine or hydrogen Possible an5bio5c therapy – metronidazole 03 peroxide based) Necro&sing Ulcera&ve Periodon&&s Necro&sing stoma&&s – Characterised by extends more than Is thought to be an necrosis of the 10mm beyond Noma ( cancrum extension/progres periodontal NUP type gingival margin or oris in Africa) may sion of NG ligament and lesions may be mucogingival follow on from NUP alveolar bone seen in pa5ents junc5on and necro5sing using oral stoma55s in recrea5onal developing parts of drugs the world More common in developing world Can become disfiguring Case study in Necro&sing Periodon&&s Gladys Born December 1988 African origin Moved to the UK aged 2 years Lived with “Mum”. Presenta&on of HIV disease Measure of T cells ↑ 1991 (Age - 2.8 years) CD4 count 612 (9%) Developmental delay Pulmonary TB Oral candidosis Bilateral paro5d enlargement Bilateral tympanic membrane perfora5ons Clinical progression 1996 Varicella-zoster infec5on 1998 Recurrent zoster infec5on 2000 Recurrent staphylococcal skin abscesses 2001 Acne vulgaris Persistent cervical lymphadeni5s 2004 Oesophageal candidosis Kukuchi lymphadeni5s 2005 Necro5zing ulcera5ve periodon55s Ini&al referral to EDH January 2006 18 years old Perinatally acquired HIV infec5on Mul5-drug resistant virus Severe immuno suppression with no peripheral CD4 count Steroid responsive mul5-system inQammatory disorder Gastrostomy “Worsening gum infec5on” since early December. Drug history 1. Prednisolone 20mg bd 2. Rani5dine 10mls od 3. Lamivudine 300mg od HAART 4. Didanosine 250mg od 5. Fluconazole 250mg od 6. Septrin 960mg 3 5mes a week 7. Azithromycin 500mg od 8. Ethambutol 300mg od 9. CiproQoxacin 750mg for 1 week 10.Valaciclovir 1g tds for 1 week. Clinical presenta&on Bilateral cervical lymphadenopathy Marked gingival ulcera5on of the palatal mucosa from UL5 to UR5 Marginal inQamma5on of the lower labial gingivae Diagnosis: Acute Necro5sing Periodon55s Image credit: Oral Med dept, EDH Image credit: Oral Med dept, EDH Image credit: Oral Med dept, EDH Management Clinical photographs Con5nue medica5on Plus Metronidazole 400mgs tds for 1 week 2% Lignocaine ointment Corsodyl and Dimam mouth rinses Intensive debridement of aMected areas at School of Hygiene and Therapy star5ng immediately. Image credit: Oral Med dept, EDH  Gladys 28.12.88 - 26.01.09 Conclusion Necrotising ulcerative gingivitis NUG is very dis5nc5ve, once seen and smelt – never forgonen! Always occurs superimposed on pre-exis5ng disease Pa5ents are likely to experience it again if OH not immaculate. Necrotising ulcerative periodontitis NUP is rare & needs specialist treatment. Thank you