DENT 267: LO3 LS1 &2- Plan Perio Therapy for Non-Biofilm Induced Bacterial Infection & fungal infections of the gingiva

non-biofilm induced gingival disease

-small % of diseases not caused by biofilm

-these diseases are not resolved after biofilm removal

-presence of biofilm can increase severity of disease

-often associated w/ pain

non-dental biofilm-induced gingival diseases and conditons: types

-genetic/developmental disorders

-specific infections

-inflammatory & immune conditions and lesions

-reactive processes

-neoplasms

-endocrine, nutritional and metabolic diseases

-traumatic lesions

-gingival pigmentation

genetic/developmental abnormalities: hereditary gingival fibromatosis

-rare, benign oral condition involving slow, progressive enlargement of max and mand attached gingiva

genetic/developmental abnormalities: infections of bacterial origin

-caused by specific bacterium not commonly found in typical bacterial biofilm

-manifest as ulcerations, chancres or mucous patches

non-biofilm induced bacterial infection

-bacteria that is not a common component of biofilm

-Gonorrhea (STD caused by bacteria Neisseria gonorrhea)

-gingiva reported to show erythematous lesions in some individuals, affecting the gingiva, buccal mucosa, lips and tongue

gingival diseases of specific bacterial origin: gonorrhea

-genital lesions, extra genital lesions- diagnosis

-by orogenital sexual contact or self inoculation

-gonococcal pharyngitis/tonsilitis

-fever, lymphadenopathy

-correlate w/ HH

-any non healing lesions will require biopsy

-gonorrhea treatment (antibiotics)

Neisseria gonorrhea associated gingival disease treatment

-antibiotic therapy for gonorrhea should resolve oral lesions

-as usual, perio therapy for gingivitis and/or periodontitis once active lesions are healed

gingival diseases of specific bacterial origin: syphilis

-Treponema pallidum- associated lesions)

-may be gingival lesions

-perio therapy for gingivitis/periodontitis once active lesion has healed

gingival diseases of specific bacterial origin: streptococcal infection

-may include acute gingivitis

-aka strep throat

-tx involves antibiotic therapy

-postpone care until on antibiotics for at least 24 hrs

fungal infections of the gingiva

-candida albicans

-white, red, ulcerative lesions

-immune compromised- AIDS, poorly controlled diabetes, blood dyscrasias, chemotherapy, long-term steroids

gingival diseases of fungal origin: Ibsen and Phelan text

-histoplasmosis (Histoplasma capsulatum)- deep fungal infection of lung and intraorally can present w/ chronic non-healing ulcers

-caused by inhalation of fungus located in soil/dust from bird and bat feces

-oral lesions can affect the gingiva

-due to implantation of organism carried by the sputum to the oral cavity

what is the antifungal therapy?

-nystatin oral rinse

-perio therapy as indicated

linear gingival erythema (LGE)

-gingival manifestation of immunosuppression

-previously referred to as HIV associated gingivitis

-gingival lesion characterized by generalized and a distinctive pattern of profound erythema (distinct red band) affecting the GM, attached gingiva and alveolar mucosa

-gingival pain not a consistent finding

-general lack of local factors like biofilm or calculus

-may be unresponsive to corrective therapy yet undergo spontaneous remission

-bleeding occurs in only 10-15% of cases

care planning for LGE (linear gingival erythema)

-cons with physician re: WBC levels and susceptibility to infection; may need to postpone care

-need for antibiotic prophylaxis

-removal of local factors, topical antimicrobials/antifungals, biofilm control, client re: etiology

-possibly metronidazole prescription