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    LRM 4-Iv Necrotizing Ulcerative Periodontitis

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    Samridhi Srivastava
    Necrotizing ulcerative periodontitis (NUP) is a severe form of periodontal disease characterized by necrosis and ulceration of the gingiva. Microscopically, NUP lesions show dense aggregates of neutrophils and necrotic cells along with a mixed microbial flora including opportunistic bacteria. NUP predominantly affects immunocompromised individuals, especially those with HIV/AIDS, and is associated with low CD4+ counts. Risk factors include poor oral hygiene, preexisting periodontal disease, smoking, malnutrition, and psychological stress which can suppress the immune response.

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    LRM 4-Iv Necrotizing Ulcerative Periodontitis

    Uploaded by

    Samridhi Srivastava
    16 views12 pages
    Necrotizing ulcerative periodontitis (NUP) is a severe form of periodontal disease characterized by necrosis and ulceration of the gingiva. Microscopically, NUP lesions show dense aggregates of neutrophils and necrotic cells along with a mixed microbial flora including opportunistic bacteria. NUP predominantly affects immunocompromised individuals, especially those with HIV/AIDS, and is associated with low CD4+ counts. Risk factors include poor oral hygiene, preexisting periodontal disease, smoking, malnutrition, and psychological stress which can suppress the immune response.

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    LRM 4-IV NECROTIZING ULCERATIVE PERIODONTITIS

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    Necrotizing ulcerative periodontitis (NUP) is a severe form of periodontal disease characterized by necrosis and ulceration of the gingiva. Microscopically, NUP lesions show dense aggregates of neutrophils and necrotic cells along with a mixed microbial flora including opportunistic bacteria. NUP predominantly affects immunocompromised individuals, especially those with HIV/AIDS, and is associated with low CD4+ counts. Risk factors include poor oral hygiene, preexisting periodontal disease, smoking, malnutrition, and psychological stress which can suppress the immune response.

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    16 views12 pages

    LRM 4-Iv Necrotizing Ulcerative Periodontitis

    Uploaded by

    Samridhi Srivastava
    Necrotizing ulcerative periodontitis (NUP) is a severe form of periodontal disease characterized by necrosis and ulceration of the gingiva. Microscopically, NUP lesions show dense aggregates of neutrophils and necrotic cells along with a mixed microbial flora including opportunistic bacteria. NUP predominantly affects immunocompromised individuals, especially those with HIV/AIDS, and is associated with low CD4+ counts. Risk factors include poor oral hygiene, preexisting periodontal disease, smoking, malnutrition, and psychological stress which can suppress the immune response.

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    NECROTIZING ULCERATIVE PERIODONTITIS

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    1
    Learning Objective:

    • Clinical features
    • Microscopic findings
    • Etiology of NUP
    • Malnutrition
    • Conclusions

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    2
    CHARACTERISTIC FEATURES OF NECROTIZING
    ULCERATIVE PERIODONTITIS

    • Historical Description – Vincent’s infection, trench mouth, ANUG

    • The term ‘necrotizing ulcerative periodontitis’ (NUP) was first adopted


    at the 1989 World Workshop on Clinical Periodontics.

    • Heightened awareness & increase in the number of NUP cases diagnosed


    & described.

    • NUG & NUP – separate diagnoses under the broader classification of


    ‘necrotizing ulcerative periodontal diseases’

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    3
    CLINICAL FEATURES

    • Necrosis & ulceration of inderdental papilla & gingival


    margin
    • Bright – red marginal gingiva that bleeds easily
    • Periodontal attachment & bone loss
    • Deep interdental osseous craters
    • Advanced lesions
    • Oral malodor, fever, malaise / lymphadenopathy

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    4
    LRM 4, IV BDS U.G CURRICULUM- DEPT OF
    5
    PERIODONTOLOGY, MRDC
    MICROSCOPIC FINDINGS

    • Cobb and coworkers demonstrated striking histologic similarites between


    NUP in HIV positive patients and previous decriptions of NUG in HIV
    negative patients.
    • Surface biofilm with mixed microbial flora
    • Dense aggregates of PMNs & necrotic cells
    • Presence of opportunistic microbes
    • Glick and coworkers found a high correlation between diagnosis of NUP and
    immunosuppression in HIV positive patients
    • Patients who presented with NUP were 20.8 times more likely to have CD4+
    counts less than 200 cells/mm3
    • Diagnosis of NUP to be marker of immune deterioration and a predictor of
    the diagnosis of AIDS

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    6
    HIV / AIDS PATIENT

    • NUP lesions in HIV +ve / AIDS patients individuals may be similar to


    HIV –ve individuals or more aggressive

    • Lesions may progress to involve larger areas of soft tissue necrosis with
    exposure of bone & sequestration of bone fragments.

    • Necrotizing ulcerative stomatitis

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    7
    ETIOLOGY OF NECROTIZING ULCERATIVE
    PERIODONTITIS
    Numerous predisposing factors have been attributed to NUG including poor
    oral hygiene, preexisting periodontal disease, smoking, viral infections,
    immunocompromised Status, psychosocial factors and malnutrition.
    MICROBIAL FLORA
    • Microbial composition similar to NUG
    • Presence of opportunistic C. Albicans, Aa, Pg, Pi, F. nucleatum &
    Campylobacter species in greater numbers.

    IMMUNOCOMPROMISED STATUS
    • NUG & NUP are more prevalent in patients with compromised or
    suppressed immune systems.

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    8
    PSYCHOLOGIC STRESS
    • Emotional stress contributes to NUG
    • Stress increases cortisol levels & sustained increases in cortisone have a
    suppressive effect on the immune response.

    MALNUTRITION
    • Necrotizing infections in severely malnourished children
    • Host defenses impaired in malnourished individuals
    • Lesions resembling NUG but that progress to become gangrenous
    stomatitis or noma have been described in children with severe
    malnutrition in underdeveloped countries.
    • NUG lesions extended from the gingiva to other areas of the oral cavity,
    becoming gangrenous stomatitis and causing exposure, necrosis and
    sequestration of the alveolar bone.

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC 9


    Conclusion
    NUG and NUP share many microbiological and clinical
    features but NUP is distinguished by more severe condition
    with periodontal attachment and bone loss. Indeed some
    patients with NUP, particularly those with compromised
    immunity, can have a severe and rapidly progressive disease. It
    appears that an impaired immune response and a lowered host
    resistance to infection are significant factors in the onset and
    progression of NUP.

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF


    10
    PERIODONTOLOGY, MRDC
    Long Questions:
    1. Etiology, clinical features, microscopic findings and management of NUP

    Short Notes:
    1. Necrotizing ulcerative periodontitis

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    11
    THANK YOU

    LRM 4, IV BDS U.G CURRICULUM- DEPT OF PERIODONTOLOGY, MRDC


    12

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