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Keumyi Chin
 Introduction
 Clinical Feature
 Diagnosis
 Management
 Prognosis
 Referred books
 Definition
Microbial disease of the gingiva in the context
of an impaired host response.
Characterized by the death and ...
 Severe necrosis of the free gingival margin,
the crest of the gingiva and interdental
papilla
VsA. B
 Also known as TRENCH MOUTH
because of its prevalence in the soldiers
working in trenches during WW1.
Vincent’s disease
F...
 H/o repeated remissions and exacerbation
 Recur in previously treated Pt
 Site?
- single
- group
- widespread.
 Tissu...
 Punched out
 Crater like depressions at the crest of
interdental papillae, may extend up to
marginal gingiva
 Surface of gingival craters is covered by a
gray pseudo membrane + necrotic tissue
debris
 Age b/w 15 – 35yrs
 Pain, i...
 Spontaneous gingival hemorrhage after
slight stimulation
 fetid odor and increased salivation
 Progressively destroy t...
 Constant radiating, gnawing pain
intensified by eating spicy or hot foods and
chewing
 Metallic taste to saliva
• Extre...
 Regional lymphadenopathy
 Slight elevation of temp.
Severe case
- high fever
 Leukocytosis
 GI disturbance
 Tachycar...
 Given by pindborg et al.
 Lesion starts as
1. Erosion of the tip of the interdental papilla
2. The lesion involving ent...
 By Horning and Cohen
 1. necrosis of the tip of the interdental papilla
 2. necrosis of the entire papilla
 3. necros...
 5. necrosis extending into buccal or labial
mucosa( necrotizing stomatitis)
 6. necrosis exposing alveolar bone
 7. ne...
 Based on clinical findings of gingival pain,
ulceration, and bleeding
 Microscopic examination of a bacterial smear or
...
 1. alleviation of acute inflammation by
reducing microbial load & removal of necrotic
tissue
 2. alleviation of genenra...
 1) first visit
 Goal- reduce microbial load & remove
necrotic tissue
 Complete evaluation of the pt
 Treatment of acu...
 Ultrasonic scaling may be preferable, with
minimal pressure against the soft tissue
 Sub gingival scaling and curettage...
 Amoxicillin 500mg O 6hr 10days
 Erythromycin 500mg 6hr
 Metronidazole 500mg twice daily 7days
 No tobacco . Alcohol. Smoking
 Rinse -mixture of 3% hydrogen peroxide and warm
water every 2hrs or twice daily with o.1...
 2 days after the first visit
 Pt is evaluated for resolution of signs and Sx
 Lesion - erythematous without a superfic...
 5 days after the second visit
- pt is evaluated for resolution of Sx, and a
comprehensive plan for the management of
the...
 Repeat scaling & root planning (if required)
 Reinstructed – plaque control measures
 Pt counseling – nutrition and sm...
1. Contouring of gingiva as adjunctive
procedure
2. nutritional supplement
 Periodontal plastic surgery
 Reshaping the gingiva surgically
Indication?
 Loss of interdental bone
 Irregularly alig...
 Carranza’s clinical periodontology vol. 1
( pg. 133 -138)
 Carranza’s clinical periodontology vol.2
( pg. 607- 610)
 T...
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Acute Necrotising Ulcerative Gingivitis

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  1. 1. Keumyi Chin
  2. 2.  Introduction  Clinical Feature  Diagnosis  Management  Prognosis  Referred books
  3. 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. 4.  Severe necrosis of the free gingival margin, the crest of the gingiva and interdental papilla VsA. B
  5. 5.  Also known as TRENCH MOUTH because of its prevalence in the soldiers working in trenches during WW1. Vincent’s disease Fusospirochetal gingivitis
  6. 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. 7.  Punched out  Crater like depressions at the crest of interdental papillae, may extend up to marginal gingiva
  8. 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. 9.  Spontaneous gingival hemorrhage after slight stimulation  fetid odor and increased salivation  Progressively destroy the gingiva and periodontal tissue
  10. 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. 11.  Regional lymphadenopathy  Slight elevation of temp. Severe case - high fever  Leukocytosis  GI disturbance  Tachycardia  Loss of appetite Sever in children
  12. 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. 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. 14.  5. necrosis extending into buccal or labial mucosa( necrotizing stomatitis)  6. necrosis exposing alveolar bone  7. necrosis perforating skin or cheek(noma)
  15. 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. 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. 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. 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. 19.  Amoxicillin 500mg O 6hr 10days  Erythromycin 500mg 6hr  Metronidazole 500mg twice daily 7days
  20. 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. 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. 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. 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. 24. 1. Contouring of gingiva as adjunctive procedure 2. nutritional supplement
  25. 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. 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)

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