Parameters of Care Summary - Acute Periodontal Diseases
Acute Periodontal Diseases:
- Clinical conditions of rapid onset that involve the periodontium or associated structures and may be characterized by pain or discomfort and infection.
- May or may not be related to gingivitis or periodontitis.
- May be localized or generalized, with possible systemic manifestations.
Acute periodontal infections include:
- Gingival abscess
- Periodontal abscess
- Necrotizing periodontal diseases
- Herpetic gingivostomatitis
- Pericoronal abscess (pericoronitis)
- Combined periodontal-endodontic lesions
Necrotizing Periodontal Disease
- Necrotizing ulcerative gingivitis (NUG) is an acute infection of the gingiva.
- Where NUG has progressed to include attachment loss, it has been referred to as necrotizing ulcerative periodontitis (NUP).
- NUG may include combinations of the following signs and symptoms:
- Necrosis and ulceration of the tips of the interdental papillae or gingival margin
- Painful, bright red marginal gingiva which bleed on slight manipulation
- The mouth may have a malodor and systemic manifestations may be present.
- In patients with NUG, there may be increased levels of personal stress, heavy smoking, and poor nutrition.
- Both NUG and NUP may be associated with HIV/AIDS and other diseases where the immune system is compromised.
- Prompt elimination of the acute signs and symptoms.
- Irrigation and debridement of the necrotic areas and tooth surfaces
- Oral hygiene instructions
- Use of oral rinses, pain control, and management of systemic manifestations, including appropriate antibiotic therapy, as necessary
- Patient counseling should include instruction on proper nutrition, oral care, appropriate fluid intake, and smoking cessation.
- A comprehensive periodontal evaluation should follow resolution of the acute condition.
- Resolution of signs and symptoms and the restoration of gingival health and function.
- Recurrence and/or progressive destruction of the gingiva and periodontal attachment.
- Factors which may contribute to non-resolution include:
- Failure to remove the causes of irritation
- Incomplete debridement
- Inaccurate diagnosis
- Patient non-compliance
- Underlying systemic conditions
- In patients where the condition does not resolve, additional therapy and/or medical/dental consultation may be indicated. These conditions may have a tendency to recur and frequent periodontal maintenance visits and meticulous oral hygiene may be necessary.
Source: Journal of Periodontology, Volume 71 Number 5, May 2000 (Supplement)
Parameters are available for download from the AAP web site.