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35 Cards in this Set
- Front
- Back
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1. What is acute necrotizing ulcerative gingivitis (ANUG)?
What is acute necrotizing ulcerative periodontitis (ANUP)? |
ANUG is a necrotizing disease that is not associated w/ loss of periodontal attachment
ANUP is when the condition is associated w/ loss of periodontal attachment **another name is Trench Mouth |
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2. Where is ANUG/ANUP limited to?
Where does the more extensive disease Noma or Mortal Stomatitis occur? |
Dentogingival region
Spreads beyond dentogingival region and extends into the alveolar mucosa and beyond **depending on extent and severity it may endanger life |
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3. What is the prevalence of necrotizing diseases?
What can predispose a person to ANUG/ANUP? What is the prevalence of the condition in hospitalized HIV infected individuals? |
Rare in industrialized nations and is more common in young adults than older individuals
Certain systemic conditions like HIV infections 11% **only about 1% in non-hospitalized HIV-positive individuals |
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4. What are some unique clinical features that characterize ANUG/ANUP?
Seven things... |
1. Quick development
2. Ulcerated necrotic gingival margins 3. Ulcerated necrotic inter-dental papillae 4. Punched-out papillae 5. Pseudo membrane covering gingival tissues 6. Heavy accumulation of plaque 7. Odor |
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5. How is the pseudo membrane in ANUG/ANUP?
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White/grayish color
Made of fibrin, necrotic tissue, leukocytes, erythrocytes and bacteria Sloughs off easily and leaves a raw bleeding surface |
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6. In HIV affected individuals how does ANUG/ANUP present itself slightly different?
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1. Associated w/ Kaposi's sarcoma
-tumor causes by herpes virus 8 2. Lesser amounts of plaque -viral infections & altered T-cell immunity are involved |
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7. Where does the disease usually start?
What happens here? |
Interdentally
1. Inter-dental papillae develop central necrosis leading to crater formation 2. Lesions spread to involved gingival margins creating continuous necrotic area |
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8. If the alveolar bone is exposed what happen?
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Infection will spread into the bone causing bone necrosis and sequestration
Necrotic bone will become loosened and forms a sequestrum |
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9. Traditionally what does ANUG/ANUP not spread beyond?
Since the course of the disease is acute what happens if left untreated? |
Does not spread beyond the mucogingival junction
May subside on its own and turns into a chronic lesion |
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10. How is the diagnosis of ANUG/ANUP made?
What other conditions can it be confounded with? (three) |
Dx is based on clinical findings
1. Herpetic gingivostomatitis 2. Desquamative gingivitis 3. Forms of leukemia |
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11. What characterizes the histopathology picture of ANUG/ANUP?
(two things) What covers the dead necrotic gingival tissue? |
1. Gingival tissue ulceration/necrosis
2. Intense inflammatory infiltration and microbial invasion Fibrin mesh encompassing -WBC and RBC -epithelial cells -bacteria |
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12. What dominates the exposed CT underneath this fibrin mesh?
What microorganisms are often detected in the tissues? |
An intense cellular inflammatory reaction involving neutrophils in superficial tissues and monocytes/plasma cells in deeper tissues
Spirochetes and fusiform bacterial rods |
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13. Why is ANUG/ANUP thought to be an opportunistic infection?
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Bacteria involved are traditional bacteria usually present in the oral cavity
**some are assoc w/ gingivitis and periodontitis **acute disease occurs when host defenses are impaired |
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14. Which bacteria usually invade the epithelial tissues in ANUG/ANUP?
Which bacterial species are present in both epithelial and CT? Which two bacteria trigger a strong IgG response? Which species can produce endotoxins? What are endotoxins involved in? |
Fusobacterium species
Treponema species Treponema and B. intermedius Treponema and Selenomonas Involved in direct and indirect tissue damage |
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15. What does direct damage by endotoxins result in?
In what type of person does ANUG/ANUP usually occur in? What is stress associated with? How does this affect immunity? |
Result in tissue necrosis
Associated w/ diminished host response and altered immunity **often develops in stressed individuals Associated w/ elevated blood steroids Steroids lower immunity |
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16. How is the immune system in individuals affected w/ ANUG/ANUP?
(two things) |
1. Lowered neutrophil chemotaxis and phagocytosis
2. Lowered lymphocyte proliferation |
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17. What are some predisposing factors for ANUG/ANUP?
Eleven factors... |
1. HIV infections
2. Previous history of ANUG/ANUP 3. Poor oral hygiene 4. Inadequate sleep 5. Stress 6. Young age 7. Poor diets 8. Recent illness 9. Excessive alcohol use 10. Smoking 11. Caucasian race |
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18. What factor overwhelms all the others?
In HIV-seronegative individuals what are perhaps the most relevant factors? |
HIV-seropositive
1. Stress 2. Poor oral hygiene 3. Young age |
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19. What does treatment and management involve?
What does controlling the acute phase include? |
Controlling the acute phase and providing follow-up care
Ultrasonic cleaning and chemical plaque control **antibiotic may be used in individuals w/ fever and lymph node involvement |
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20. What does follow-up care include?
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1. Comprehensive periodontal assessment
2. Corrective surgery to rectify periodontal damage |
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21. What is an odontogenic abscess?
Where can the periodontal abscess occur? How is the periodontal abscess classified? |
Localized purulent inflammatory lesion
Can be localized to the gingival tissues or could involve deeper supporting structures of periodontium 1. Periodontitis related 2. Non-periodontitis related |
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22. What is the periodontitis related abscess associated with?
When will the drainage of it be blocked? What will the locked-in infection induce? (two things) |
Associated w/ plaque biofilm and periodontal infections
If the opening of a deep periodontal pocket is closed 1. Intense inflammatory reaction 2. Massive numbers of neutrophils **neutrophils induce tissue breakdown and pus formation |
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23. What is exacerbation of a chronic periodontitis lesion usually associated with?
(two things) What can the swollen gingival margins do? |
1. Acute inflammation
2. Swelling of gingival margins Can block drainage and result in development of an abscess |
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24. How can a periodontal pocket close post-therapy?
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1. Scaling dislodges fragment of calculus blocking the pocket orifice
2. Gingival margins may shrink and tighten around tooth 3. Blockage and development of periodontal abscess |
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25. How can the development of an abscess occur following periodontal surgery?
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Failure to remove all calculus can impair healing and result in development of abscess
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26. What is non-periodontitis related abscess associated with?
What are some common causes of it? |
Not associated w/ plaque biofilm
1. Root morphology alterations 2. Foreign body impaction *due to broken toothpick, orthodontic device or food particle |
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27. What is the prevalence of a periodontal abscess?
Which teeth are most commonly affected? Why this tooth? |
8% to 14% (high)
Molar teeth Perhaps due to complicated anatomy (multiple roots and furcations) |
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28. What is the pathogenesis of the periodontal abscess?
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1. Occlusion of orifice of periodontal pocket blocks drainage
2. Bacteria and bacterial products inside pocket initiate intense inflammatory reaction 3. Neutrophils dominate lesion 4. Neutrophils die and macrophages phagocytose them turning them into pus |
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29. What determines the course of the infection?
What bacteria are associated w/ a periodontal abscess? |
Interplay between bacterial virulence and host resistance
Same bacteria associated w/ chronic periodontitis |
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30. What is the microbial composite of the periodontal abscess?
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Non-motile gram-negative strict anaerobe species
1. P. gingivalis 2. Prevotella intermedia 3. Fusobacterium nucleatum 4. Bacteriodes forsythus 5. Spirochetes |
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31. How are the gram-positive and facultative anaerobic species in the microbiota of the periodontal abscess?
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Have a strong proteolytic activity that contributes to severity of tissue damage and abscess formation
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32. How is the diagnosis of a periodontal abscess made?
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Clinical and radiographic picture
Gingiva is swollen, tender and fluctuant Radiographic image reveals vertical defect associated w/ affected tooth |
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33. What is a periodontal abscess usually confused with?
How can they be differentiated? |
Periapical abscess
Periapical abscess is associated w/ non-vital tooth Periodontal abscess is associated w/ vital tooth |
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34. Under microscope how is the gingival CT of a periodontal abscess?
What does the bacteria invade? |
Gingival CT appears heavily infiltrated w/ foci of neutrophils and lymphocytes
Invasion of both epithelium and CT |
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35. What is the most effective treatment to manage the acute problem of a periodontal abscess?
When is antibiotic treatment indicated? What should be done after managing the acute problem? |
Debride and degranulate the abscess
If fever or lymph nodes are involved Allow time for healing then bring patient back to manage underlying cause |
