Acute Necrotising Ulcerative Gingivitis

1. ACUTE NECROTISING ACUTE NECROTISING
ULCERATIVE ULCERATIVE
GINGIVITISGINGIVITIS
Dr shabeel pnDr shabeel pn

2. •Acute necrotising ulcerative gingivitis is a
relatively rare condition and is
characterised clinically by necrosis of the
free gingival margin,the crest of the
gingiva and the interdental papillae,etc.

3. •SYNONYM-
- VINCENT’S INFECTION
-TRENCH MOUTH
- ACUTE ULCEROMEMBRANEOUS
GINGIVITIS
-PHAGEDENIC GINGIVITIS
-FUSOSPIROCHETAL GINGIVITIS

4. EPIDEMIOLOGYEPIDEMIOLOGY
•It frequently occur in an epidemic pattern.
•Especially apparent during World War I-
and the term ‘trench mouth’ originated.
•Sporadic outbursts also occurred in World
War II
•Global increase associated with HIV
infection
•More common among young and middle
aged adults,15-35 years old.

5. ETIOLOGYETIOLOGY
•Most investigators believe that it’s caused
by a fusiform bacillus and Borrelia vincentii
-a spirochete.
•Some workers also included vibrio and
coccal forms as agents in the etiology of
this disease.
•Frequently occurs in the presence of
psychologic stress.

6. •Stress-related corticosteroids are thought
to alter T4/T8 lymphocyte ratios and may
cause the decreased neutrophilic
chemotaxis and phagocytic response.
•Immunosuppresion.
•Smoking.
•Local trauma.
•Poor nutritional status.
•Poor oral hygeine.
•Inadequate sleep.

7. •Recent illness.
•Sudden change in lifestyle
•Debilitating disease(eg:infectious
mononucleosis,bacterial
infections,diabetes,blood
dyscrasias,etc)
•Emotional stress
•Down’s syndrome

8. CLINICAL FEATURESCLINICAL FEATURES
•Males are more frequently involved
•Gingiva becomes red and painful.
•Later on a sharply “punched-out” erosion
of the interdental papillae occurs.
•Gingiva often covered by a
“pseudomembrane” and moreover it has a
pronounced bleeding tendency and
always produces extremely unpleasant
fetid odor.

9. •Rarely, the gingival lesion may extend to
the mucosal surfaces of soft palate and
tonsils.
•Patient often develops
headache,fever,malaise and
lymphadenopathy,etc.
•Difficulty in taking food due to increased
salivation and a metallic taste in the
mouth.

10. •Most of the patients develop systemic
manifestation in the form of leukocytosis,
tachycardia and gastro intestinal disturbance
etc.
•Process sometimes lead to a loss of attachment
and the development of associated
periodontitis(necrotizing ulcerative
periodontitis)or spread to adjacent soft
tissue(necrotizing ulcerative
mucositis;necrotizing stomatitis)
•If necrotizing infection extends through the
mucosa to the skin of the face,it is typically
termed noma(cancrum oris)

11. REFERENCEREFERENCE
•ORAL AND MAXILLOFACIAL
PATHOLOGY(2
ND
EDITION)-NEVILLE
•ESSENTIALS OF ORAL
PATHOLOGY(2
ND
EDITION)-SWAPAN
KUMAR PURKAIT
•SHAFER’S TEXTBOOK OF ORAL
PATHOLOGY(5
TH
EDITION)