[Music] necrotizing periodontal diseases so there are three types of necrotizing periodontal diseases and we're going to look at each of these um sections and we're also going to look at an image or a picture of an example of a necrotizing a periodontal disease so the first thing we need to examine is this word over here necrotizing what does that word mean well necrotizing comes from the word necro roses and necrosis is basically a term that is defined as tissue death so something is dying the tissues are dying so when we look at necrotizing gingivitis or ng what does that mean that means that the gum or the gingival tissues is dying so let's look at this example here here are examples of necrotizing gingivitis here because it's gingivitis there's no bone loss so we don't really see a lot of we don't see any recession actually and we see inflammation we would see bleeding and the tissues in the gums may not be as evident but it there is necrosis the tissues are dying sometimes it's hard to tell with um these images because it doesn't look as if the gums have disappeared or have been eaten away because necrosis means that the gums have been eaten away and we don't necessarily see a much of it but there is uh there's definite pain involved so with people who have with patients who have necrotizing gingivitis their number one complaint would be pain and if someone tells you they have pain and they have severe bleeding severe inflammation it probably could be necrotizing gingivitis and the reason why we would rule out periodontitis is because in these situations there's no bone loss with gingivitis there is no bone loss nor do we see any recession right but if we look at the other one necrotizing periodontitis this is necrosis this is tissue death of what of the gums of the pdls of the bone and we can see that here so if we look at this image here necrotizing periodontitis look at how the papilla has been punched out or cratered that is scooped up the papilla is dying um you can see that over here this definite tissue that happening lots and lots of bleeding and again the number one complaint is pain with all the other conditions you with all the other periodontal conditions pain is not a number one concern but when someone tells you they're in pain and they probably even have a fever swollen lymph nodes that's a sign that this person could be suffering from necrotizing diseases in this case it's necrotizing periodontitis you see this grace membrane that's over here you could actually wipe it off and this gray white membrane is known as a pseudo-membrane and this is a very typical thing that you would find in patients that have necrotizing diseases so this is an example of a pseudomembrane which will look at in another slide the last and most severe type of necrotizing periodontal disease is necrotizing stomatitis and this is severe this is and it actually says here severe necrosis severe death tissue depth and when we're looking at an example of this we're like this is like the the worst case you can see and let's look at this picture look at that the gums are gone the gums are dying the bone could even be dying it's significant it's severe so when we're looking at necrotizing stomatitis we're looking at tissue that severe necrosis past the gums past like it could even be the tongue that could be involved it could be the cheeks that could be involved it could even be the palette and that's the example we were looking at and bone can also be resorbed so it's the most severe and the rarest so it's not common at all a type of necrotizing periodontal disease so here is necrotizing stomatitis and if you look at this person's palette you can definitely see tissue death necrotizing periodontal diseases have other words such as trench mouth this is common in soldiers in world war one so in world war one these soldiers this typically happens with young people so these young male soldiers had undergone severe trauma severe stress and that's what usually happens when you're under severe stress you could get necrotizing periodontal diseases and at that time they called it trench mouth vincent infection a nug necrotizing ulcerative gingivas dermatitis those are all different terminology to mean the same thing remember the main symptom that the client will tell you is that it's very painful all the other all the other periodontal disease there is no pain but with this one there is pain there is tissue necrosis there's tissue death and the tissues are like so red and it just bleeds spontaneously it just bleeds just like that sometimes you don't even touch it and you see bleeding and the amount of tissue death can happen so quickly like within days you can see the tissue dying so it is quite severe remember the pseudomembrane that i was talking about that's what this is referring to it's like a gray layer of tissue and it covers like the dying areas the necrotic areas with the dying areas of the gum and if you look at the papilla it looks kind of created or punched out like scooped out like there's no papilla here and that's typical of necrotizing periodontal diseases sometimes you don't see any papilla um you'll see a lot of plaque you'll see a lot of blood you might see um sometimes a lot of saliva with a strong smell and again pain is your number one indicator that they won't eat they won't brush their teeth because they're in just immense pain and even if you palpate their lymph nodes you'll notice that they do have swollen submandibular which is like right here submandibular lymph nodes and even cervical lymph nodes so if you palpate it it would be it would be swollen and possibly even tender and of course they would have they could have a fever they would just feel tired and just they can't eat because it's in they're in so much pain so things we should um keep in mind again again here we see some more images of cratered or necrotic propeller where propeller is just being scooped out or here you can see like the gums have just been um it's like the tissues are just dying in the gums so what causes necrotizing periodontal disease well you could have a poor host immune response so your immune response is not um as strong and and why could this happen remember we said we talked about stress earlier where those um soldiers in world war one experienced it a lot because they were going through so much emotional stress um it can even happen to students we do see it with young students who are going through a lot of stress when they're in college or university and then alcohol smoking that all plays a big role typically they've noticed that it happens with caucasian people people who usually eat um or have poor nutrition or poor eating habits just like college students and the age that they've noticed is 22 to 24 years old people that usually get it so if you have a client that has necrotizing periodontal disease you could definitely um refer them to a periodontist you can also teach them um you know to try to eat um and what we say is just because they can't eat because it's so painful at least take ensure or boost so that they can get a dietary replacement at least that way they're getting their nutrients in at least that way they're getting their vitamins and minerals inside in them and then if they're smoking we really need to um educate them on like stopping to smoke because that can trigger it a lot more alright so that is necrotizing periodontal disease for you guys