INFEKSI BAKTERI NON SPESIFIK

 

• Gingivitis

  • Infectious gingivitis
    • Bacterial origin
    • Non bacterial (herpetic gingivostomatitis, HIV, and fungal infection)

• Introduction

  1989 ungkap onset dan keparahan

• Workshop 1989 categorised periodontitis as:

  • Prepubertal
  • Juvenile (localized and generalised)
  • Adult
  • Rapidly progressive

• 1993 categorised :

  • Adult
  • Early onset periodontitis

• 1996 determined insufficient new evidence to change the classification

• 1999 reclassified under the category of Necrotizing Periodontal Disease (NPD) as:

  • Chronic
  • Aggressive (localized and generalised)
  • Necrotising
  • Manifestation of systemic disease

• Caton, 2018

  

• Definisi

  Ulserasi dan nekrosis pada papillary gingiva

• KLASIFIKASI

  Menurut Horning dan Cohen diklasifikasikan berdasarkan tahapan penyakit

  • Stage I nekrosis pada puncak interdental papilla
  • Stage II nekrosis masuk ke papilla
  • Stage III ekrosis berkembang sampai margin gingiva
  • Stage IV nekrosis berkembang sampai attached gingiva
  • Stage V nekrosis berkembang ke dalam mukosa bukal dan lingual
  • Stage VI nekrosis sampai pembukaan tulang alveolar
  • Stage VII nekrosis menembur kulit dan pipi

  NUG NUP NUS NOMA merupakan satu proses necrotizing gingivostomatitis

  

• Gejala

  • Rasa sakit yang amat sangat
  • Kondisi akut ulseratif-inflamatori pada gingiva dan periodontium
  • Dikaitkan dengan indeksi polymikrobial

• Epidemiologi

  Prevalence di negara berkembang dengan gizi buruk sangat tinggi

  • Namun sudah mulai berkurang sejak abad 20

  • Young adult between 15 and 30 Y.O

  • Preceded by chronic gingivitis

  • Begins with ulceration and necrosis in the col area

    col - a craterlike area of the interproximal oral mucosa joining the lingual and buccal interdental papillae

    

• More susceptible :

  • Immunocompromised patient
  • Receiving chemotherapy
  • Down syndrome
  • Smoking
  • Equal F & M

• Clinical Finding

  • NUG/NUP may or may not be associated with fever and malaise
  • Submandibular lymphadenopathy is usually present
  • NUG = rapid and acute onset
  • Excessive salivation
  • A metallic taste
  • Sensitivity of gingiva
  • Scaterred punched-out ulceration

  Malodor

  • Gingival bleeding
  • Dental plaque
  • Malnutrition
  • Painfull swelling free gingiva
  • May extend into palatal region

  Trench mouth = WW 1 and WW2

  • Vincent disease = description of lesion in the tonsil and pharynx region by Franch Vincent

• Distingushing characteristic :

  • fetid odor
  • A gray pseudomembran form over the necrotic gingiva
  • Spontaneous bleeding

• Etiopathogenesis

  • Bacterial mix infection
    • Prevotella intermedia
    • Alpha-hemolytic streptococci
    • actinomyces spesies
    • Selenomas
    • Porphyronomonas gingivitis
    • Treponema
    • Fusobacterium nucleatum

  Viral and fungal may seen on immunocompromised patient

  • May progress to NOMA
  • NUS develop from the spreading necrotised to adjacent tissues

  Fusospirochetal organism are common in the periodontal tissues

  • Permissive environment of an immunocompromised host allows microbe to proliferate
  • Endotoxins production causes tissues destruction
  • Immunologic activation
    • Reduced neutrophil chemotaxis and phagocytosis
    • Poor control of infection

  Underlying systemic disease NUG and NUP can spread rapidly from gingiva to periodontium and into the soft tissues

  • Rise to cancrum iris, noma or orafacial gangrene
  • Devastating in children malnutrition and poverty
  • Noma/cancrum oris/orofacial gangrene ;
    • F. Necrophorum play important role
    • Produce dermonecrotic toxin, hemolysin, leukotoxin and proteolytic enzyme

• Laboratory

  • Gingival sulcus secretion
  • Biopsy not helping

• Management

  • Supportive care

  • Relief of pain

  • Definitive treatment

  • 2 phases :

    • Acute
    • Maintenance phase treatment

  • Definitive treatment:

    • Debridement
    • Chlorhexidine digluconate
    • Hydrogen peroxide
    • Antibiotic : gram-negative anaerobes
    • Metronidazole

  • Maintenance :

    SRP and Root Planing

  • NOMA :

    • agrresive treatment : nutrition supplementation
    • Antibiotic
    • Tissues debridement
    • Plastic surgery

• Simpulan by me

  • NUG

    di interdental papila

    trench mouth

    fetid odor, metallic taste

    tx: CHX

  • NUP

    → di seluruh papila, margin, attached ggv, ada LOA

    ada yg HIV non HIV

    klo HIV: linear gingival erythema

  • NUS

    → sampe mukosa, expose tulang

    gambaran pseudomembran putih kekuningan bekas nekrosis

  • NOMA / Cancrum oris

    → perforasi kulit

    gangren

    krn malnutrisi

Blood Diseases

Blood diseases associated with periodontal disease:

• LEUKEMIA

  • Keganasan pada hematopoietic stem cell

  • Patogenesis

    • Diawali pembentukan keganasan stem cell yang berproliferasi menuju sel darah perifer
    • Proliferation of clone of abnormal hematopoietic cell with impaired differentiation, regulation, apoptosis
    • Rapid disease course which progress over week to month
    • Culminating in bone marrow failure
    • Kerusakan bone marrow
    • Cytopenia
    • Berakibat kematian akibet infeksi, bleeding atau keduanya

  • Etiologi

    • Peningkatan sel darah putih immature dalam peredaran darah

  • Klasifikasi berdasarkan histologi :

    • Myeloid = ditemukan lebih banyak granulosit atau monosit dan sedikit eritrosit/megakariosit
    • Lymphocytic / lymphoblastic

  • Klasifikasi berdasarkan behaviour / secara klinis :

    • Akut
    • Kronis

    

  • Four principal diagnostic categories :

    • Acute myelogenous leukaemia (AML)
    • Acute lymphocytic leukaemia (ALL)
    • Chronic myelogenaous leukemia (CML)
    • Chronic lymphacytic leukemia (CLL)

  

• Etiologi

  • Tidak diketahu pasti
  • Faktor genetic dan lingkungan
  • Infeksi virus
  • Kemoterapi
  • Radiasi
  • M>L

• Clinical findings

  • Fatigue, mud lelah, dyspnea
  • Joint pain
  • Splenomegaly,hepatomegaly, limfadenopati,infiltrasi sel ganas pada organ
  • Infeksi
  • 65 % gingival bleeding, petechiae, ecchymosis
  • Enlargement, ulceration, oral infection

• Management

  • Kemoterapi
  • Supportive→ nutrisi, tranfusi
  • Antibiotic
  • Kemoradiasi
  • Transplants

• NEUTROPENIA

  • Kelainan darah = jumlah netrofil dalam sirkulasi darah < 1500 cell per mikroliter

  • Severe neutropenia = netrofil < 200 cell per microlitre = agranulosit

  • Etiologi

    Penyebab tidak diketahui pasti

    • Congenital = genetik
    • Acquired = pasca infeksi, transplants tulang, radioterapi, defisiensi nutrisi, drugs

    Imunocompromis

    • Penurunan netrofil disebabkan oleh penurunan produksi atau peningkatan kerusakan netrofil
    • Benign ethnic neutropenia
    • Def. B12, copper dan folat akibat malabsorbsi dapat menghambat prod. Netrofil

    Infeksi : bakteri,virus

    • Penyakit autoimun

• Clinical findings

  • Peny. Periodontal

  • Premature loss teeth

  • Enamel hypoplsia, caries, delayed eruption

  • Pre pubertal periodontitis

    

• Management

  • Peningkatan OH = munurunkan infeksi
  • Antiseptic : chlorhexidine
  • Antibiotic : tetracycline
  • Pemberian GCSF granulocyte colony-stimulating factor = sitokin pertumbuhan dan diff. Netrofil