Necrotizing ulcerative gingivitis

NECROTIZING ULCERATIVE GINGIVITIS

1. Good Morning

2. NECROTIZING ULCERATIVE GINGIVITIS Nilesh Patil 3 rd yr BDS SDK Dental college Nagpur

3. PREDISPOSING FACTORS CLINICAL FEATURES BACTERIOLOGIC EXAMINATION HISTOLOGIC FEATURES TREATMENT & PROGNOSIS

4. NECROTIZING GINGIVOSTOMATITIS Necrotizing ulcerative gingivitis, necotizing ulcerative periodontitis & necrotising stomatitis are together termed necrotizing gingivostomatitis. Predisposing factors include emotional stress, immunosuppression, HIV infectin, smoking, malnutrition & pre-existing gingivitis.

5. NECROTIZING ULCERATIVE GINGIVITIS Also known as- Vincent’s infection Trench mouth Acute ulceromembranous gingivitis Fusospirochetal gingivitis Acute ulcerative gingivitis

6. This inflammatory condition involves primarily free gingival margin, the crest of gingiva & interdental papillae. Rarely the lesion spreads to the soft palate & tonsillar area & in such conditions the term vincent’s angina is applied. Pain, interdental ulceration & gingival bleeding is considered diagnostic triad .

7. NUG is caused by a fusiform bacillus & Borrelia vincentii - a spirochete.

8. PREDISPOSING FACTORS Psychological stress Immunosuppression Smoking Upper respiratory tract infection Local trauma Poor nutritional status Poor oral hygiene

9. CLINICAL FEATURES The disease is characterized by the development of painful, hyperemic gingiva & sharply punched-out crater like erosion of the interdental papillae of sudden onset. The ulcerated remnants of the papillae and the free gingiva bleed when touched. A fetid odor ultimately develops that is extremely unpleasent.

10. Patient complains of inability to eat because of severe gingival pain & the tendency for gingiva bleeding. Patient suffers from headache, malaise & low grade fever. Excessive salivation with metallic taste to the saliva is often noted.

11. BACTERIOLOGIC EXAMINATION Smear of material from gingiva in case of NUG shows vast number of fusiform bacilli & oral spirochete, filamentous organism, vibrios, cocci, desquamated epithelial cells & varying numbers of polymorphonuclear leukocytosis.

12. HISTOLOGIC FEATURES Microscopic examination of gingiva in NUG reveals an acute gingivitis with extensive necrosis. The surface epithelium is ulcerated & replaced by thick fibrous exudate, or pseudomembrane, containing PMN leucocytes & microorganism. The connective tissue is infiltrated by dense numbers of PMN leukocytes .

13. TREATMENT & PROGNOSIS Superficial cleansing of the oral cavity in early stage of the disease with chlorhexidine, diluted hydrogen peroxide or warm saltwater. This is followed by scaling & polishing. Antibiotic can be given.