Periodontal Disease Notes And Short Essays

Oral Medicine Periodontal Disease Important Notes

1. Widening of PDL space is seen in

• Osteosarcoma
• Chondrosarcoma
• Scleroderma
• Trauma from occlusion

2. Obliteration of PDL space is seen in

• Hypercementosis
• Ankylosis
• Hypofunction of teeth
• Paget’s disease

3. Papillon Lefevre syndrome

• Juvenile periodontitis
• Palmar plantar keratosis
• Calcification of falx cerebri

4. Desquamative gingivitis represents oral manifestations of

• Lichen planus
• Cicatricial pemphigoid
• Pemphigus

Oral Medicine Periodontal Disease Long Essays

Question 1. Describe clinical features, differential diagnosis, and treatment of acute necrotizing ulcerative gingivitis.

Answer:

Acute Necrotising Ulcerative Gingivitis

• It is a relatively rare condition and is characterized clinically by necrosis of the free gingival margin the crest of the gingiva and the interdental papillae

Acute Necrotising Ulcerative Gingivitis Clinical Features:

• Age – 15-35 years
• Sex – Common in males
• Initially, the gingiva becomes red and painful
• Further, punched-out erosion of the interdental papillae occurs
• Gingiva is covered by a “pseudo-membrane”
• Bleeding occurs spontaneously or on slight provocation
• It produces an extremely unpleasant odor
• The gingival lesion may extend to the mucosal surfaces of the soft palate and tonsils
• It leads to difficulty in deglutition, mastication
• Increased salivation and a metallic taste in the mouth

Read And Learn More: Oral Medicine Question and Answers

Acute Necrotising Ulcerative Gingivitis Generalized Symptoms:

• Headache
• Fever, malaise
• Lymphadenopathy
• Leukocytosis
• Tachycardia
• Gastrointestinal disturbances

Acute Necrotising Ulcerative Gingivitis Differential Diagnosis:

• Primary acute herpetic gingivostomatitis
  • Occurs more frequently in children
  • Characterized by vesicular eruption
    • Erosive lichen planus
    • Drug allergy

Acute Necrotising Ulcerative Gingivitis Treatments:

1. Removal of pseudomembrane by gently swabbing the area with a cotton pellet
2. Rinsing the mouth with a glassful of an equal mixture of warm water and 3% hydrogen peroxide

• Twice daily rinse with 0.12% chlorhexidine
  • Antibiotics:
    • Penicillin V – 250-500 mg or erythromycin 250-500 mg 6 hourly for 7 days
    • Metronidazole 400 mg 8 hourly for 7 days
  • Gingival curettage: After the active phase of the disease
  • Supportive treatment:
    • Fluid consumption
    • Administration of nutritional supplements

Oral Medicine Periodontal Disease Short Essays

Question 1. Pericoronitis.

Answer:

Pericoronitis

• It refers to inflammation of the gingiva about the crown of an incompletely erupted tooth

  Pericoronitis Types:

• Acute
• Sub-acute
• Chronic

Pericoronitis Clinical Features:

• It occurs most often in the mandibular third molar area
• The space between the crown of the tooth and the overlying gingival flap leads to the accumulation of food debris and bacteria
• Thus it is chronically inflamed and infected
• Various degrees of ulceration occurs
• The lesion is red, swollen, and suppurating
• It is tender on palpation
• The pain radiates to the ear, throat, and floor of the mouth
• Presence of foul taste
• Inability to close the jaws
• Swelling of the cheek in the region of the angle of the jaw
• Lymphadenitis
• Fever, leukocytosis, and malaise occur

Pericoronitis Treatment:

• Antibiotics
• Phenoxymethyl penicillin 250 mg 4 times daily
• Metronidazole 200 mg 3 times daily for 7 days
• Drainage
• To allow evacuation of pus
• Extraction – during the sub-acute phase
• Operculectomy – If retention of 3rd molar is preferred
• Extraction of maxillary 3rd molar – when mandibular 3rd molar fully erupts

Question 2. Gingival Enlargement.

Answer:

Gingival Enlargement

• An increase in the size of the gingiva is termed gingival enlargement

Gingival Enlargement Types:

1. Inflammatory enlargement:

•  Chronic:
  • It originates as a slight ballooning of the interdental papilla and marginal gingiva
  • In early stages, it produces a life-preserver-shaped bulge around the involved teeth
  • This bulge can increase in size until it covers part of the crown
  • It can be localized or generalized
• Acute Inflammatory enlargement:
  • Gingival abscess:
    • It is a localized, painful, rapidly expanding lesion that is usually of sudden onset
    • It is generally limited to the marginal gingiva or interdental papilla
    • Initially, it appears as a red swelling with a smooth, shiny surface
    • Within 24-48 hours the lesion usually becomes fluctuant and pointed with a surface orifice from which purulent exudates may be expressed
  • Periodontal abscess: It produces enlargement of the gingiva along with the supporting periodontal tissues

2. Drug-induced enlargement: Characterized by bead-like enlargement of the interdental papilla and extends to the facial and lingual gingival margins

3. Enlargements associated with systemic diseases:

• Conditioned enlargement:
  • Types:
    • Hormonal (Pregnancy, Puberty)
    • Nutritional (Vit. C deficiency)
    • Allergy
  • Features:
    • Gingival edema
    • Increased inflammatory response to dental plaque
    • Gingiva is bright red/magenta in color
    • It is soft and friable
    • It has a smooth, shiny surface
    • Bleeding occurs spontaneously or on slight provocation
    • The lesion appears as a discrete, mushroom-like, flattened spherical mass that protrudes from the gingival margin
•  Enlargement associated with the systemic disease: An existing inflammation initiated by dental plaque

4. Neoplastic enlargement:

• Benign Tumor of Gingiva:
  • Fibroma
  • Papilloma
  • Leukoplakia
• Malignant tumor of Gingiva:
  • Carcinoma
  • Malignant melanoma

5. False enlargement: They may appear as a result of an increase in the size of the underlying osseous or dental tissues

Question 3. Halitosis.

Answer:

Halitosis

• It is an unpleasant odor exhaled in breathing

Halitosis Classification:

• Physiologic halitosis
• Pathologic halitosis
• Pseudo halitosis

Halitosis Causes:

• Physiologic
  • Mouth breathing
  • Medications
  • Aging
  • Fasting, starvation
  • Tobacco
  • Food
• Pathology:
• Periodontal infection
• Tongue coating
• Stomatitis
• Faulty restoration
• Unclean dentures
• Pathologic lesions
• Abscess

Halitosis Diagnosis:

• Subjective organoleptic method: It is used as a benchmark
• Gas chromatography: Measure molecular levels of volatile sulfur compounds
• Halimeters: Measure the level of sulfide gas
• BANAtest:

Halitosis Treatment:

• Improvement of oral hygiene and periodontal health
• Tongue brushing should be advised
• Rinsing or gargling with an effective mouthwash
• Halita – It reduces volatile sulfur compound levels

Question 4. Investigation and management of Primary Herpetic Gingivostomatitis.

Answer:

Primary Herpetic Gingivostomatitis Investigations:

• Patient history
• Clinical findings
• Direct smear
  • The material is obtained from the base of the lesion and smeared and stained
  • The finding of multinucleated cells with swelling, ballooning, and degeneration is adequate for the diagnosis
  •  Inoculation of the virus from a suspected site to tissue culture
• Serological studies

Primary Herpetic Gingivostomatitis Management:

• Local applications:
  • Using 8% zinc chloride, Talbot’s iodine, phenol, riboflavin, thiamine, etc.
  • Chlortetracycline is used as a mouthwash.
• Palliative treatment:
  • Plaque, food debris, and superficial calculus are removed
  • Relief in pain is obtained with diclonine hydrochloride
• Supportive treatment: Copious fluid intake and systemic antibiotic therapy i.e. aspirin is administered

Oral Medicine Periodontal Disease Short Answers

Question 1. Name drugs causing gingival enlargement.

Answer:

Drugs causing gingival enlargement

• Nifedipine
• Cyclosporine
• Dilantin sodium

Question 2. Epulis.

Answer:

Epulis

• It refers to solid swelling situated on the gum

Epulis Types:

1. Granulomatous Epulis:

• Precipitating factors
  • Caries tooth
  • Denture
• Poor oral hygiene
• It manifests as a mass of granulation tissue around the teeth on the gums
• It is soft to firm fleshy mass and bleeds on touch

2. Fibrous Epulis:

• It is the commonest form
• It arises from the periodontal membrane
• It is present on the gum
• It may undergo a sarcomatous change
• It is a firm polypoidal mass, slow-growing, and non-tender

3. Giant cell Epulis:

• It is an osteoclastoma arising in the jaw
• It presents as hyperemic vascular oedematous, soft to firm gums with indurated underlying mass due to expansion of the bone
• It may ulcerate and result in hemorrhage
• X-ray shows bone destruction with ridging of walls

4. Carcinomatous Epulis:

• This is an epithelioma arising from the mucous membrane of the alveolar margin
• Typically, it presents as a non-healing, painful ulcer
• It slowly infiltrates the bone

Question 4. Drug-induced gingival enlargement

Answer:

drugs causing gingival enlargement:

Gingival Enlargement Clinical Features

• It occurs 3 months after initiation of phenytoin therapy
• Common in younger individuals
• Generalized distribution but severe in the maxilla
• The site involved- marginal gingiva and interdental papilla
• Appears as a painless, bead-like enlargement
• Interferes with occlusion
• Has lobulated surface
• Firm to resilient in consistency
• No tendency to bleed

Oral Medicine Periodontal Disease Viva Voce

1. Drug-inducing gingivitis – phenytoin, cyclosporine, and nifedipine
2. Phenytoin-induced gingivitis starts in interdental papillae
3. Herpetic gingivostomatitis usually occurs in children and young adults
4. Pseudomembrane formation occurs in ANUG