Necrotizing Ulcerative Gingivitis
Necrotizing ulcerative gingivitis (NUG) is a distinct, painful infectious disease primarily of the interdental and marginal gingiva. It is characterized by a symptom triad that includes gingival pain, ulcer, and bleeding.
- Trench mouth
- Acute necrotizing ulcerative gingivitis (ANUG)
- Vincent stomatitis
- Fusospirochetal gingivitis
- Acute ulcerative gingivitis
How common is Necrotizing Ulcerative Gingivitis?
- Unlike in the developing world, NUG is seen rarely in developed countries.
- Slightly more prevalent in males than in females because the latter group tend to have better oral hygiene.
- •Occurs in the second and third decades of life in the developed world.
- •In contrast, it affects young children more often in developing countries.
What increase the risk – Risk Factors
- •Poor oral hygiene
- •Smoking/chewing tobacco
- •Alcohol use
- •Drug addiction
- •Poor socioeconomic status
- •Psychological stress
- •Preexisting gingivitis
- •Lack of sleep
- •Living near livestock
- •History of prior NUG
- •Recent illness
- •Underlying systemic diseases
- •Various infections such as measles, malaria, and infestation with intestinal parasites
- 1.Dermatomyositis (DM)
- 2.Steroid use
- 4.Use of chemotherapeutic drugs
- 5.Leukemia and other malignancies
What causes Necrotizing Ulcerative Gingivitis?
- •Often caused by both Fusobacterium and spirochetes
- •For the most part, it appears to result from an opportunistic infection in a host with lowered resistance
What are the Clinical Features?
- •Onset of the disease is usually sudden
- •Severe gingival pain
- •Gingival tissue is inflamed, edematous, friable, and necrotic; the normal pointed interdental papillae are blunted, but there is no loss of attachment
- •Gingival bleeding with little or no provocation
- •Punched out ulcerations are seen along the interdental papillae around the anterior incisors and posterior molars. A grayish-white pseudomembrane often covers these ulcers. These punched out ulcers along the pseudomembrane are pathognomonic of NUG
- •Other features include:
- 2.Alteration in taste, such as a metallic flavor
- 3.Wooden teeth feeling
- 5.Fever and fatigue
- 6.Cervical lymphadenopathy
How is this Diagnosed?
- •Based on the clinical features
- •WBC may be elevated
- •Gram stain and aerobic/anaerobic culture
- •Dental x-ray or x-ray of face to check on the extent of the disease
- •HIV testing is recommended for patients’ refractory to antibiotic therapy
- •Acute herpetic gingivostomatitis
- •Aphthous stomatitis
- •Chronic periodontal disease
- •Desquamative gingivitis
- •Gonococcal and streptococcal gingivostomatitis
- •Oral candidiasis
- •Ludwig angina
- •HIV-associated idiopathic ulcerations
How is this treated?
- •Improve oral hygiene by flossing and brushing at least twice a day.
- •Improve nutrition and hydrations.
- •Eliminate contributing factors such as smoking, alcohol, carbonated beverages, spicy/hot foods, poor nutrition, stress, and so on.
- •Antibiotic coverage for 5 to 10 days. Most recommend oral penicillin V 250 to 500 mg orally every 6 to 8 hr and metronidazole 250 to 500 mg orally every 8 hr. Tetracycline is given instead of penicillin in patients allergic to the latter. As an alternative one could give only clindamycin instead of the drug combination of penicillin and metronidazole.
- •Rinsing the mouth at least twice a day with warm saline (1/2 teaspoon of salt in 1 cup of water), 0.12% chlorhexidine, or dilute 3% hydrogen peroxide (mixed half and half with water).
- •Pain is controlled with oral pain medications and topical application of 2% viscous lidocaine (15 ml oral rinse every 6 to 8 hr as needed) to the inflamed gum.
- •Surgical debridement is needed in severe cases.
- •Scaling and root planing following the resolution of infection and the acute inflammation.
- •At times reconstructive surgery may be needed.
- •Cancrum oris (noma) results when NUG involves the deeper tissue
- •Vincent angina from the involvement of tonsils and pharynx
- •Necrotizing ulcerative periodontitis
- •Loss of teeth
- •Periodontal abscess
- •Alveolar bone destruction
- •Dramatic relief of symptoms within 24 hr of initiating antibiotics and supportive treatment is characteristic.
- •Risk of recurrence is high.
- •Good oral hygiene
- •Use of power toothbrush is better than a manual brush
- •Good general health including proper nutrition, sleep, and exercise
- •Routine dental checks
- •Avoidance of smoking and alcohol
- •Stress management
Not a communicable disease