Download - Acute Gingival Lesions
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1. Acute Gingival Abscess
2. Acute Herpetic gingivostomotitis
3. Pericoronitis
4. Streptococcal Gingivostomotitis
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5. Acute Narcotizing Ulcerative Gingivitis
6. Acute Candidasis
7. Aphthous Stomatitis
( Necrotizing periodontal diseases)
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Gingival Abscess
Localized painful rapidly expanding lesion
of sudden onset.
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Etiology
Due to impaction of foreign object such
as tooth brush bristle or fibrous food.
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Clinical Features
Short duration
Limited to marginal gingiva and interdental papilla.
Appears as red swelling with smooth surface.
Lesion become fluctuant within24 to 48 hr.
Adjacent teeth often sensitive to percussion.
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Management
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Acute Herpetic Gingivostomatitis
( A.H.G.S. )
Infection of oral cavity caused by:
HERPES SIMPLEX VIRUS
Occurs most frequently in infants and children
younger than 6years of age.
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Clinical Features
The condition appears as diffuse erythematous,
shiny involvement of gingiva.
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In its initial stage characterized by presence
of discrete spherical Grey vesicles which
occurs on the gingiva, labial and buccal
mucosa, soft palate, pharynx,
sublingual mucosa,& the togue.
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Oral Symptoms
Generalized soreness of the oral cavity
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Extraoral Systemic Signs and Symptoms
- Herpetic involvement of lips and face
-Cervical Lymphadenitis and Fever
are common
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A.H.G.S. is contagious
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Histpathology
The fully developed vesicles:
Is cavity in the epithelial cells with occasional PMNs.
Inclusion body are found in nuclei of epithelial
cells bordering vesicles
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Deferential Diagnosis & Diagnosis
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- ANUG.
- Erythema Multiforme.
- Bullous lichen planus
- Desquamative gingivitis
- Aphthous stomatitis
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Management
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1. Palliative measurement.
2. Remove local deposits.
3.Topical anesthetitic M. Wash.(Dyclonine hydrochloride
4. Lidocaine viscouse- 2% or 5% aqueous diphenhydramine.
5. Mouth wash &antibiotics.
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PERICORONITIS
It’s the inflammation of the gingiva in relation
to the crown of an incompletely erupted tooth.
It occurs most frequently in mandibular third molar.
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Clinical Features
Acute pericoronitis is identified by varying
degrees of involvement of the pericoronal
flap and adjacent structure.
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Complications
Pericoronal Abscess
May spread posteriorly into the oropharyngeal area
and medially to the base of the tongue.
Peritonsillar Abscess
Cellulitis
Ludwigs Angina
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Treatment
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STREPTOCOCCAL GINGIVOSTOMATITIS
Rare condition, More commonly, secondy infection
Of the gingiva with Haemolytic streptococci occurs
In tissue aleady irritated inflamed, eg. Around partialy
Erupted teeth or due to lowered body immunity .
Diffuse or Marginal Erythema the gingiva and other
Oral tissue become intensely red and sensitive and lymph
gland enlarged.
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Acute Candidasis ( Moniliasis or Thrush)
mucosa Most common mycotic oral infection
Overgrowth of candida Albicans
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1. Alleviated resistance to infection
E.g. prolonged antibiotic therapy
Xerostomia
Poor oral hygiene
2. Compromised immune system E.g. AIDS
Corticosteroids therapy.
Early infancy
3. Generalized patient debilitation E.g.
Uncontrolled diabetes
Anemia
Advanced systemic diseases
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Clinical Features
Characterized by crudy white area on the oral
mucosa that is adherent.
When forcibly wiped off leave a red bleeding surface?
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Diagnosis
1. History
2. Clinical finding
3. Smear & biopsy
4. culture
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Management
1. Nystatin suspension (100,000 Iu)
1 tsp. - held in the mouth for 5 minutes and then swallowed,
repeated four times a day.
2. AmphotericinB 10mg tablet
3. Clotrimazole troches
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APHTHOUS STOMATITIS
Idiopathic, noninfectious, inflammatory disease
characterized by recurrent ulcers involving non
keratinized oral mucosa.
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Aphthous stomatitis occurs as
-Occasional aphthae
-Acute aphthae
-Recurrent aphthae
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Etiology is unknown
Predisposing factors
Hormonal disturbances
Allergic phenomena
Gastrointestinal disorders
Psychosomatic
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Clinical Features
They are usually circular ulcers less than 1 cm in diameter.
Have light yellow central area surrounded by prominent
band of erythema.they are usually painful
Occurs in the oral cavity any where except the
attached gingiva, hard palate and lips
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Management
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1. Tetracycline M. wash.
2. Hydrocortisone acetate ointment 0.5% or
betametazone ointment o.1%
3. O.2% chlorhexidine as m. wash
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Acute Necrotizing Ulcerative Gingivitis
A.N.U.G. is an inflammatory destructive disease
of the gingiva presents characteristic
clinical signs and symptoms.
Necrotizing gingivitis
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Necrtizing gingivitis ; necrotizing periodontitis & N. stomatitis
They rapidly destructive and debilitating, and they appear
to represent various stages of the same disease process.
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Etiology:
Unknown
Certain bacterial strains has been incriminated
Spirochaetal organisms and Fusiform bacilli
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Predisposing Factors
local
Systemic
Psychosomatic factors
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Clinical Feature
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CLINICAL FEATURES
It can be classified as
ACUTE, SUBACUTE OR RECURRENT.
It affects elders. Relatively uncommon in children.
No definitive duration.
History- Sudden onset sometimes followed an episode of
debilitating disease or acute respiratory tract infection.
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Oral signs
Characteristic lesions are
PUNCHED OUT CRATER LIKE DEPRESSIONS at crest of
interdental popilla, subsequently extend to marginal gingiva.
The surface of the gingival craters is covered by grey pseudo-
membranous sloughs demarcated from the rest of the gingiva by a
linear erythema.
Spontaneous gingival hemorrhage.
Fetid odor.
Increased salivation.
It may progressively destroy gingiva and underlying periodontal
tissues
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Oral symptoms
Lesions extremely sensitive to touch.
Constant radiating gnawing pain.
Metallic foul taste.
Excessive ‘pasty’ saliva.
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Extraoral signs and symptoms
Local lymphadenopathy and slight elevation in temp. in mild and
moderate cases.
In severe cases, marked systemic complications.
In rare cases, NOMA, fusospirochetal meningitis, peritonitis,
pulmonary infection, toxemia, fatal brain abscess.
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Diagnosis: based on clinical finding and history.
Differential Diagnosis:
1. Streptococcal gingivo-stomatitis.
2. Gonococal stomatitis.
3. Vincent's angina
4. Agranulocytosis.
5. Acute herpetic gingivo-stomatitis.
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Management
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TREATMENT
Alleviation of acute symptoms
first complete patient’s information, general and systemic.
Complete intraoral examination and bacterial smear if require.
Local treatment should be in orderly sequence.
For non-ambulatory patients, vigorous treatment should not be
undertaken until systemic symptoms subside.
General removal of necrotic pseudomembrane with cotton pellet
saturated with H2O2 (hydrogen peroxide). Superficial scaling with
ultrasonic scalers first. Later scalers and curettes are used after some
days of gingival shrinkage.
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Systemic orally, one of the following is usually given.
PENICILLIN –250 or 500mg 6 hourly for 5-7 days.
For penicillin sensitive patients ERYTHROMYCIN 250 or 500mg 6
hourly for 5-7 days.
METRANIDAZOLE 250 or 500mg 8 hourly for 5-7 days.
Supportive treatment – fluids, analgesics, nutritional supplements.
After the acute condition subsides, recontour gingiva (gingivoplasty)
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Instructions to ANUG patient
Avoid alcohol, tobacco, and condiments.
Rinse with equal amounts of water and 3%
H2O2 every 2 hours.
Avoid excessive physical exertion.
Use soft toothbrush with bland dentrifice.
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