NON – PLAQUE INDUCED CONDITIONS:
STD
Herpes infection
Candida infection
Hereditary
Food/paste/restoration allergy
Iatrogenic
Traumatic
Foreign body in sulcus
DRUG INDUCED GINGIVAL ENLARGEMENT
Dilantin (phynotoin )don't give with metronidazole
Gingival hyperplasia – drug induced
Gingival enlargement by plaque
Drugs:
o Phenytoin antiepileptic
60% chances – most common cause for DIGE
o Nifedipine
Antihypertensive
Ca-channel blockers
o Cyclosporins – immunosuppresants
20% chances – for organ transplants
Management
o 1st line Rx – scaling and replacement of drugs
o 2nd line Rx – gingivectomy
ANUG /TRENCH MOUTH ULCER/ VINCENT STOMATITIS
o Pseudomembrane
o Acute necrotising ulcer gingivitis
o Organisms causing
Fusiform
Treponima denticola (spirochete) }red complex gram -ve
Borelia Vincenti
o Precipitating factors
Smoking, pericoronitis(infection)
DOWN’S SYNDROME, bed ridden patients
o C/F
Multiple punched out ulcers in Interdental papilla + marginal gingiva**
Halitosis**
Dull pain
Sometimes fever
Pt. physiological stress, smoker before 1 yr he reported to the clinic, he has necrosis gingival , redness, no attachment loss , treated by mechanical debridement and systemic antimicrobial therapy.**
o If not treated, it will lead to complications
Necrotising ulcerative periodontitis
Cancrum oris / NOMA
Investigations required – dark field microscope
o Rx
Antibiotic if required – amox 500 mg + metro 400 mg
Mouth wash – H2O2 + CHX
1st step in Rx – removal of pseudomembrane
Then medication + mouth wash
Surgery
Extraction of offending tooth done only after 4 weeks ie after ANUG
subsides
Anterior – gingivoplasty shaping of gingiva done as cosmetic
correction of ANUG
