Fast Facts: Perio Edition Episode 40
[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello and welcome to Fast Facts Perio Edition. Buckle up, we're moving in to talking about non dental biofilm induced gingivitis. And this week begins the conversation over several weeks of identifying patients that can have some type of an inflammatory condition in their mouth, but it's not necessarily related to the presence of biofilm. Moreover, this enlargement of the gingiva is associated with some other type of transient condition. This week, we're going to look at genetic or developmental disorders and the first of very specific infections that can affect a gingival lesion.
We're going to begin by looking at genetic or developmental disorders, and that begins by talking about this condition called hereditary gingival fibromatosis. You guys, these are patients that just present with a generalized fibrous enlargement of the gingiva. We can see these, you know, tuberosities enlarged, the free and attached gingiva are enlarged. The retro molar pads are enlarged. These are patients who can present with a relatively, quote unquote, gummy smile. And genetically, you may be able to trace that back to higher concentrations of fibrosis notated within the family itself.
These are patients that although there is an enlargement of the gingiva itself, the enlargement is due to this genetic or developmental disorder. And it's not due to the fact that there's biofilm, meaning your treatment plan for this patient, although we want to keep the tissue cleansable and healthy, is going to expand beyond performing some type of periodontal therapy or debridement on the patient and more so looking at how we can control that fibromatosis. We're also going to look at specific infections this week, and in order to do that, we're going to look at infections of the gingiva of bacterial origin.
And for this, we're going to look at a few, beginning with necrotizing diseases. Now, the main piece that I want you to know about this is that when a patient presents with necrotizing disease, necrotizing periodontal disease, absolutely there is an etiology of bacteria. More so what we're specifically talking about is the fact that with patients like this, we can see destruction in the form of a crater of the papillae. And that, of course, is due to the necrosis of necrotizing periodontal diseases.
We can also see patients that present with gonorrhea, for example. And when patients present with this observation in the mouth, this will be some type of a lesion or ulceration or maybe a fiery red mucosa with a pseudo membrane over it. We can also see syphilis in the mouth. We can see fiery red or edematous ulcerations. We can also see syphilis chancres in the mouth. And of course, I think we all recall from microbiology class seeing chancres in other parts of the body. But we can also absolutely see a syphilis chancre in the mouth and I want to caution my colleagues sometimes that asymptomatic chancre in the mouth can look like a history of some scar tissue from a tongue piercing. But if you ask the patient about it, they'll tell you they never had a tongue piercing. You might be looking at an asymptomatic syphilis chancre or a mucous patch. We can also see changes in a patient's gingiva associated with Mycobacterium tuberculin so tuberculosis patients could present with a primary or a secondary nodular or ulceration of the gingiva.
And finally, we can have what's called streptococcal gingivitis. This is kind of an interesting type of gingivitis because it's not associated with plaque. It's associated with an infiltration of high strains of streptococcus. And sometimes these are preceded by some type of an upper respiratory tract infection. In all of the cases that we just listed, these are patients in which we're going to see an observation of an enlargement of the gingiva of some kind. Yet in most of these cases, the ideal treatment modality to address this is not going to be the removal of biofilm, but rather looking at the opportunity to refer this patient to another treating physician to address the systemic or genetic challenge.
Thank you for joining this week. As we talked about non dental biofilm induced gingivitis as seen in hereditary gingival fibromatosis and bacterial origin. Stay tuned as next week we look at additional opportunities to identify patients in a non dental biofilm induced gingival status. Have a great week.
This has been another episode of Fast Facts - Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website www.KatrinaSanders.com Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We'll see you next week for another Fast Fact!
