Keumyi Chin

Introduction Clinical Feature Diagnosis Management Prognosis Referred books

Definition

Microbial disease of the gingiva in the context of an impaired host response.

Characterized by the death and sloughing of gingival tissue

Presents with characteristics sign and symptoms

Severe necrosis of the free gingival margin, the crest of the gingiva and interdentalpapilla

VsA. B

Also known as TRENCH MOUTH because of its prevalence in the soldiers

working in trenches during WW1.

Vincent’s diseaseFusospirochetal gingivitis

H/o repeated remissions and exacerbation Recur in previously treated Pt Site?- single - group- widespread. Tissue destruction – longstanding disease

immunosuppressed pt

Bone loss occurs => NUP

Punched out Crater like depressions at the crest of

interdental papillae, may extend up to marginal gingiva

Surface of gingival craters is covered by a gray pseudo membrane + necrotic tissue debris

Age b/w 15 – 35yrs Pain, interdental ulceration, and gingival

bleeding are the diagnostic triad Interdental papillae - inflamed, edematous,

and hemorrhagic.

Spontaneous gingival hemorrhage after slight stimulation

fetid odor and increased salivation

Progressively destroy the gingiva and periodontal tissue

Constant radiating, gnawing pain intensified by eating spicy or hot foods and

chewing

Metallic taste to saliva

• Extremely sensitive to touch

• Excessive amount of pasty saliva

Regional lymphadenopathy Slight elevation of temp.Severe case- high fever Leukocytosis GI disturbance Tachycardia Loss of appetiteSever in children

Given by pindborg et al. Lesion starts as1. Erosion of the tip of the interdental papilla2. The lesion involving entire papilla &

marginal gingiva3. Attached gingiva also involved4. Exposure of the bone with complete loss of

interdental papilla, marginal gingiva, and attached gingiva.

By Horning and Cohen 1. necrosis of the tip of the interdental papilla

2. necrosis of the entire papilla

3. necrosis extending to gingival margin(NUP)

4. necrosis extending to attached gingiva

5. necrosis extending into buccal or labial mucosa( necrotizing stomatitis)

6. necrosis exposing alveolar bone

7. necrosis perforating skin or cheek(noma)

Based on clinical findings of gingival pain, ulceration, and bleeding

Microscopic examination of a bacterial smear or biopsy specimen does not give specific picture.

Histologic picture greatly resembles marginal gingivitis, periodontal pockets, pericoronitis or primary herpetic gingivostomatitis

1. alleviation of acute inflammation by reducing microbial load & removal of necrotic tissue

2. alleviation of genenralized sx – fever& malaise

3. correction of systemic conditions that contributes to the initiation or progression of the gingival change

1) first visit Goal- reduce microbial load & remove

necrotic tissue Complete evaluation of the pt Treatment of acute lesion is primary goal. Topical anesthetic applied 2-3min > gently swabbed. Remove pseudo

membrane and nonattached surface debris cleaning with warm water

Ultrasonic scaling may be preferable, with minimal pressure against the soft tissue

Sub gingival scaling and curettage are C/I at this time

This may extend the infection to the deeper tissues and cause bacteremia

Amoxicillin 500mg O 6hr 10days

Erythromycin 500mg 6hr

Metronidazole 500mg twice daily 7days

No tobacco . Alcohol. Smoking

Rinse -mixture of 3% hydrogen peroxide and warm water every 2hrs or twice daily with o.12% chlorhexidine solution

Get adequate rest . Avoid excessive physical exertions

Confine tooth brushing to the removal of surface debris with a bland dentifrice and an ultra soft brush

An analgesic such as NSAID – ibuprofen

2 days after the first visit Pt is evaluated for resolution of signs and Sx Lesion - erythematous without a superficial

pseudo membrane Shrinkage of the gingiva may expose

previously covered calculus, which is gently removed.

Instructions are given same as previously

5 days after the second visit - pt is evaluated for resolution of Sx, and a

comprehensive plan for the management of the pt’s periodontal conditions is formulated

Hydrogen peroxide rinse – discontinuedChlorhexidine mouthwash – continued 2

or3 wks Supportive therapy (e.g rest, appropriate

fluid intake, soft nutritious diet)

Repeat scaling & root planning (if required) Reinstructed – plaque control measures Pt counseling – nutrition and smoking

cessation Appointments should be scheduled for t/t1. Chronic gingivitis 2. Periodontal pockets3. Pericoronal flap4. Local irritants Patient is reevaluated after 1 month.

1. Contouring of gingiva as adjunctive procedure

2. nutritional supplement

Periodontal plastic surgery Reshaping the gingiva surgically

Indication? Loss of interdental bone Irregularly aligned teeth Loss of entire papilla Formation of a shelf like gingival margin

Why? To restore normal gingival architecture Esthetic concern

Carranza’s clinical periodontology vol. 1( pg. 133 -138)

Carranza’s clinical periodontology vol.2 ( pg. 607- 610)

Textbook of periodontology and oral implantology (pg. 167-171)