Necrotising Periodontal Diseases
Necrotising Periodontal Diseases
Objectives
By the end of these revision notes, you should:
What are the necrotising periodontal diseases?
Necrotising periodontal diseases (NPDs) are a group of severe inflammatory conditions that affect the periodontal tissues but are not contagious. In the updated 2017 classification system, the naming conventions have changed from the previous classification. The necrotising periodontal diseases include necrotising gingivitis (mildest form), necrotising periodontitis and necrotising stomatitis. In the worst cases, this can progress to cancrum oris (noma). This is often fatal.
Overall, these diseases are characterised by rapid tissue destruction, severe pain and usually systemic involvement.
What are the causes of necrotising periodontal diseases?
The necrotising periodontal diseases are caused by a mixed fusiform/spirochaete bacterial infection of a susceptible host. The common bacteria implicated are Prevotella intermedia, Fusobacterium spp and Treponema spp.
Histologically, there are four zones that are described:
- Bacterial zone – spirochaetes and other bacteria
- Neutrophil-rich zone – neutrophils, leukocytes and some bacteria
- Necrotic zone – tissue necrosis and presence of spirochaetes and fusiform bacteria
- Spirochaetal infiltration zone – tissue is well preserved but spirochaetes are present
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