Peio_lec# 12 dr: omar karadsheh . Done by :lobna alhunaiti /Asma saleem/Amer khaled

Acute periodontitis

Today we will talk about acute periodontal condition, We will focus mainly on:

1- abscess 2- necrotizing condition

Acute lesion: it is a sudden onset associated with pain, swelling & it will be for limited duration with will defined medical criteria.

*All acute diseases we will talk about are look the same, so you have to know the underlying causes & what is the diagnosis. Usually its clinical dilemma.

So as an example of acute condition:

Traumatic lesion / Bacterial lesion/ Viral lesion/ Fungal lesion/ Ulcers/ Allergy Notes: we will focus on bacterial lesion.

Traumatic lesion such as :

1-thermal 2- Physical 3- Chemical

Physical:

1- such as you may all do with abur or elevator

2- Tooth brushing ,

aggressive brushers usually have:

a. Recession, just bucally (no mesial or distal)

B. very good oral hygiene

C. frictional keratosis (hyper keratosis)

D. ulcer

Bacteria trauma caused by??

You might think its ulcer, if you refer it to OM Dept. but after ttt its appear due to mechanical trauma. So history is always important.

Thermal :

most of the time appears on the palate as petechia .

Chemical :

hydrogen peroxide ia a mouth wash that should be diluted up to 2-3 %, more than this it might cause burn.

---------------------------------------------------------------------------------------------------

** Management of traumatic lesion:

Remove the cause

Gives the patient mouth wash

You might give them the antibiotic, if it gets infected.

You can give them oral paste , to cover traumatic lesion & ulcers

Note: its some time good in treatment of aphthous ulcer.

(Important part of the lec)bacterial lesion.

We will talk mainly about:

Necrotizing lesion

Abscess

necrotizing ulcerative gingivitis:

*definition from the book :" NUG is usually identified as an acute disease. However, the term acute in this case is a clinical descriptor and should not be used as a diagnosis because there is no chronic form of the disease. "

Oral signs:

- The trauma present in papilla, Characteristic lesions are punched-out, craterlike depressions at the crest of the interdental papillae, subsequently extending to the marginal gingiva and rarely to the attached gingiva and oral mucosa.

" Figure 10-1"

-The surface of the gingival craters is covered by a gray, pseudomembranous slough, demarcated from the remainder of the gingival mucosa by a pronounced linear erythema; { Linear erythema " line separate between healthy & disease gingiva}

(Figure 10-1 Necrotizing ulcerative gingivitis. A, Typical punched-out papilla between mandibular canine and lateral incisor, covered by grayish white pseudomembrane. B, More advanced case showing destruction of papillae resulting in irregular marginal contour)

- The gingival has certain spots of necrosis.

- Spontaneous bleeding

- Pain; that is intensified by eating spicy or hot foods and chewing.

Facts about NUG:

It has another name:-

trench mouth disease ; because the solders during wars stay in the trench"""

& due to stress the immunity decrease so they were more susceptible to that disease.

it occurs mainly in children

The incidence equally in male and female

Most of the time occur in student, mainly during exam.

It happen in high prevalence in HIV patient 70% of them.

Relation of Bacteria to the Necrotizing Ulcerative Gingivitis Lesion:

Like most of them oral disease its polymicrobial, mainly Gram ve bacteria mainly fusiform bacillus and a spirochetal organism.

Both are motile, Gram ve, anaerobic bacteria.

Predisposing factors:

Poor oral hygiene

Smoking

Menstruation

Stress

Immunocompromised patient

Malnutrition

Inadequate sleep

You have to know that all these factor cause decrease immunity;and anything decrease the immunity it will cause NUG. : , , , :"(

Main feature of it :- ( mainly 3)

Very acute sever pain

Pitched out papilla 3

Spontaneous bleeding

Characteristic smell , foul smell , but its not considered as main feature ( )

Pseudo membrane " might or might not be found "

Tasty thick saliva

It might have systemic signs such as fever

Linear erythema

All what we describe before it was for The initial stages of the disease:

Necrosis at the lip of papilla etc

How we diagnosis is it?

By history & examination, there is no need for biopsy because what you will see in it is necrotic tissue & bacteria that cause most of the disease that occur in the oral cavity.

So the most imp point is history & examination & clinical feature that we talked about.{{ Very acute sever pain / Pitched out papilla/ Spontaneous bleeding}}

Differential Diagnosis.

1-Desquamative gingivitis 2- Herpes 3- Aggressive periodontits

If you dont treat it??

Most of the time it resolves by itself, but there will be high prevalence of recurrence & it might progress to & reaches periodontal ligament & at the time we will call it "ulcerative periodontitis."

Also it might progress to" necrotizing ulcerative stomatitis", if it reaches to the oral mucosa.

Also it might progress to "noma"

Usually after treatment you end up with:-

Scaring

Step??9:50 gingiva

Negative architect

It might progress or recur

Acute necrotizing ulcerative periodontitis:

The only difference from NUG is that Acute necrotizing ulcerative periodontitis destruction reaches to the periodontal ligament ( support apparatus )

Clinical feature:

-Usually there is inter proximal crater like depressions

-attachment loss

- bone loss

-Reverse architecture

-Buccal surface of the papilla is higher

If it reaches the bone; the bone may sequestered by the body. " like in osteomylitis"

It didnt occur in healthy pt.; it occurs in immunocompromised &HIV patients.

There will be Sever bone loss on radiograph.

Acute necrotize ulcerative stomatitis:-

Futures:

-Progression reaches the mucosa

-Destruction very sever

-The pt. may have oraoantral fistula.

-it occurs In HIV pt.

-it is life treating & might be fatal.

- acute necrotizing ulcerative stomatitis.

Before treatment after treatment

Sever Destruction - scaring, and thick gingival.

Goal of treatement for these cases

- The pt. comes with severe pain; for sure you must not start with scaling; so we tend to elevate the symptoms & control local factor.

-You clean or till him to clean his mouth gently to elevate the symptoms.

-treat periodontal disease that cause periodontitis; such as control systematic disease that cause it .

How to clean:-

1st clean the wound by gauze after you dip it with saline or H2O2

*Note:H2O2 is mouth wash; & due to the fact that the causative agent of the disease of bacteria is anaerobic; so something release O2 is good.

2nd you give the pt. chlorhexidine, because its antibacterial & anti plaque & anti-inflammatory.

-you can do supra gingival scaling; just gentle.

-if there is systemic sign such as fever or malais , you give him anti biotic for anaerobic bacterial such as METRONIDAZOLE 500 mg ; 1x 3 x7.

-you give analgesic to reduce the pain; e.g.: ibuprofen.

-If the patient is smoker or malnourish (vitamin or fluid deficiency), you have to control this.

-You have to see them after 1-2 days and at that time you can do deeper scaling and see the response.

-After one week you have to do a definite treatment such as scaling and root panning and then you follow up and treat it as chronic periodontitis.

Since the disease tends to recur, we have to follow them up and you have to give the OH instructions.

Note: Sometimes after healing the shape of the gingiva become not desirable for cleaning and there is defect interdentally. You might need to do a small surgery (gingivoplasty) to make the gingiva more aesthetic, cleansable and favorable.

If the disease didnt respond to the treatment, you might:

Not remove the cause of the disease.

No clean it will.

Take an incorrect diagnosiss, it might be viral cause.

The patient might not compliant.

The patient has an acute inflammatory condition that is not diagnosed.

Abscesses:

Abscess: LOCALIZED collection of bus, necrotic tissue, WBC and tissue breakdown product.

-So it might be:

1- Gingival

2- Periodontal

3-periocoronal. (Periocronitis: operculum that usually found above partially erupted wisdom < you might treat it locally or by surgical procedure and extraction.

Gingival abscess:

It is swollen collected bus, found on the