Acute Necrotising Ulcerative Gingivitis

1. Keumyi Chin

2.  Introduction
 Clinical Feature
 Diagnosis
 Management
 Prognosis
 Referred books

3.  Definition
Microbial disease of the gingiva in the context
of an impaired host response.
Characterized by the death and sloughing of
gingival tissue
Presents with characteristics sign and
symptoms

4.  Severe necrosis of the free gingival margin,
the crest of the gingiva and interdental
papilla
VsA. B

5.  Also known as TRENCH MOUTH
because of its prevalence in the soldiers
working in trenches during WW1.
Vincent’s disease
Fusospirochetal gingivitis

6.  H/o repeated remissions and exacerbation
 Recur in previously treated Pt
 Site?
- single
- group
- widespread.
 Tissue destruction – longstanding disease
immunosuppressed pt
Bone loss occurs => NUP

7.  Punched out
 Crater like depressions at the crest of
interdental papillae, may extend up to
marginal gingiva

8.  Surface of gingival craters is covered by a
gray pseudo membrane + necrotic tissue
debris
 Age b/w 15 – 35yrs
 Pain, interdental ulceration, and gingival
bleeding are the diagnostic triad
 Interdental papillae - inflamed, edematous,
and hemorrhagic.

9.  Spontaneous gingival hemorrhage after
slight stimulation
 fetid odor and increased salivation
 Progressively destroy the gingiva and
periodontal tissue

10.  Constant radiating, gnawing pain
intensified by eating spicy or hot foods and
chewing
 Metallic taste to saliva
• Extremely sensitive to touch
• Excessive amount of pasty saliva

11.  Regional lymphadenopathy
 Slight elevation of temp.
Severe case
- high fever
 Leukocytosis
 GI disturbance
 Tachycardia
 Loss of appetite
Sever in children

12.  Given by pindborg et al.
 Lesion starts as
1. Erosion of the tip of the interdental papilla
2. The lesion involving entire papilla &
marginal gingiva
3. Attached gingiva also involved
4. Exposure of the bone with complete loss of
interdental papilla, marginal gingiva, and
attached gingiva.

13.  By Horning and Cohen
 1. necrosis of the tip of the interdental papilla
 2. necrosis of the entire papilla
 3. necrosis extending to gingival margin(NUP)
 4. necrosis extending to attached gingiva

14.  5. necrosis extending into buccal or labial
mucosa( necrotizing stomatitis)
 6. necrosis exposing alveolar bone
 7. necrosis perforating skin or cheek(noma)

15.  Based on clinical findings of gingival pain,
ulceration, and bleeding
 Microscopic examination of a bacterial smear or
biopsy specimen does not give specific picture.
 Histologic picture greatly resembles marginal
gingivitis, periodontal pockets, pericoronitis or
primary herpetic gingivostomatitis

16.  1. alleviation of acute inflammation by
reducing microbial load & removal of necrotic
tissue
 2. alleviation of genenralized sx – fever&
malaise
 3. correction of systemic conditions that
contributes to the initiation or progression of
the gingival change

17.  1) first visit
 Goal- reduce microbial load & remove
necrotic tissue
 Complete evaluation of the pt
 Treatment of acute lesion is primary goal.
 Topical anesthetic applied
 2-3min > gently swabbed. Remove pseudo
membrane and nonattached surface debris
 cleaning with warm water

18.  Ultrasonic scaling may be preferable, with
minimal pressure against the soft tissue
 Sub gingival scaling and curettage are C/I at
this time
 This may extend the infection to the deeper
tissues and cause bacteremia

19.  Amoxicillin 500mg O 6hr 10days
 Erythromycin 500mg 6hr
 Metronidazole 500mg twice daily 7days

20.  No tobacco . Alcohol. Smoking
 Rinse -mixture of 3% hydrogen peroxide and warm
water every 2hrs or twice daily with o.12%
chlorhexidine solution
 Get adequate rest . Avoid excessive physical exertions
 Confine tooth brushing to the removal of surface
debris with a bland dentifrice and an ultra soft brush
 An analgesic such as NSAID – ibuprofen

21.  2 days after the first visit
 Pt is evaluated for resolution of signs and Sx
 Lesion - erythematous without a superficial
pseudo membrane
 Shrinkage of the gingiva may expose
previously covered calculus, which is gently
removed.
 Instructions are given same as previously

22.  5 days after the second visit
- pt is evaluated for resolution of Sx, and a
comprehensive plan for the management of
the pt’s periodontal conditions is formulated
Hydrogen peroxide rinse – discontinued
Chlorhexidine mouthwash – continued 2
or3 wks
 Supportive therapy (e.g rest, appropriate
fluid intake, soft nutritious diet)

23.  Repeat scaling & root planning (if required)
 Reinstructed – plaque control measures
 Pt counseling – nutrition and smoking
cessation
 Appointments should be scheduled for t/t
1. Chronic gingivitis
2. Periodontal pockets
3. Pericoronal flap
4. Local irritants
Patient is reevaluated after 1 month.

24. 1. Contouring of gingiva as adjunctive
procedure
2. nutritional supplement

25.  Periodontal plastic surgery
 Reshaping the gingiva surgically
Indication?
 Loss of interdental bone
 Irregularly aligned teeth
 Loss of entire papilla
 Formation of a shelf like gingival margin
Why?
 To restore normal gingival architecture
 Esthetic concern

26.  Carranza’s clinical periodontology vol. 1
( pg. 133 -138)
 Carranza’s clinical periodontology vol.2
( pg. 607- 610)
 Textbook of periodontology and oral
implantology (pg. 167-171)