INDIAN DENTAL ACADEMY  Leader in Continuing Dental Educationwww.indiandentalacademy.com
Necrotizing ulcerative gingivitis is aninfectiousdisease of the gingiva causinggingivalbleeding, gingival ulceration and p...
History    Necrotizing ulcerative gingivitis had been recognizedin the 4th century BC by Xenophon, who mentioned thatGreek...
Synonyms      Vincent’s disease      Fusospirochetal gingivitis      Trench mouth      Acute ulcerative gingivitis      Ne...
ETIOLOGY                    Role of bacteria•       A specific infectious disease should be associatedwith a specific etio...
Loesche et al Constant flora            Variable flora• P. intermedia             Heterogeneous• Fusobacterium            ...
Role of host response•Nutritionaldef.•Alcohol/drug            immunodeficiencyabuse•stress      www.indiandentalacademy.com
CLINICAL FEATURES                      Oral signsPunched - out , craterlike depressionsat the crest of the interdental pap...
Other clinical signsSpontaneous gingival hemorrhageFetid odorIncreased salivationwww.indiandentalacademy.com
Punched out                           interdental papillaLesions with progressive tissue destruction       www.indiandenta...
Oral symptoms  Lesions sensitive to touch  Radiating , gnawing pain  “Metallic” foul taste  “Pasty” salivawww.indiandental...
Systemic signs & symptoms        High fever        Lymphadenopathy        Pulse rate        Leukocytosis       Loss of app...
Clinical course              Pindborg et al•   Erosion of tip of papilla•   Lesion extending to marginal gingiva•   Lesion...
Horning and cohen•   Stage 1 : necrosis of tip of papilla•   Stage 2 : necrosis of entire papilla•   Stage 3 : necrosis ex...
Listgarten 1965     Bacterial zone     Neutrophil rich zone     Necrotic zone     Spirochetal infiltration zonewww.indiand...
HistopathologySurface epithelium replaced by meshwork offibrin , necrotic epithelial cells , PMN’s etcConnective tissue is...
www.indiandentalacademy.com
DIAGNOSIS    Clinical findings    Bacterial smear    Biopsy specimenwww.indiandentalacademy.com
Clinical findings   Gingival pain   Ulceration   Bleedingwww.indiandentalacademy.com
Bacterial smear       Differential diagnosis of ANUG from                                      Diphtheria                 ...
Differential diagnosis Herpetic gingivostomatitis Chronic periodontitis Desquamative gingivitis Diphtheritic & syphilitic ...
THANK YOU FOR WATCHINGwww.indiandentalacademy.com   www.indiandentalacademy.com
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Acute necrotising ulcerative gingivitis , ANUG /certified fixed orthodontic courses by Indian dental academy

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Acute necrotising ulcerative gingivitis , ANUG /certified fixed orthodontic courses by Indian dental academy

  1. 1.   INDIAN DENTAL ACADEMY Leader in Continuing Dental Educationwww.indiandentalacademy.com
  2. 2. Necrotizing ulcerative gingivitis is aninfectiousdisease of the gingiva causinggingivalbleeding, gingival ulceration and pain. www.indiandentalacademy.com
  3. 3. History Necrotizing ulcerative gingivitis had been recognizedin the 4th century BC by Xenophon, who mentioned thatGreek soldiers were affected with “sore mouth and foulsmelling breath”. In 1778, Hunter described the clinicalfeatures of this disease and differentiated it from scurvyand chronic periodontitis. www.indiandentalacademy.com
  4. 4. Synonyms Vincent’s disease Fusospirochetal gingivitis Trench mouth Acute ulcerative gingivitis Necrotizing gingivitiswww.indiandentalacademy.com
  5. 5. ETIOLOGY Role of bacteria• A specific infectious disease should be associatedwith a specific etiology. The bacterial etiology ofNecrotizing ulcerative gingivitis provides one of ourstrongest examples of a primarily bacterial etiology in aperiodontal disease.    Plaut in 1894 and Vincent in 1896 first proposed thisbacterial etiology.• They both reported that fusiform-spirochete bacteriaflora were associated with lesions of NUG. www.indiandentalacademy.com
  6. 6. Loesche et al Constant flora Variable flora• P. intermedia Heterogeneous• Fusobacterium array of bacteria• Treponema www.indiandentalacademy.com
  7. 7. Role of host response•Nutritionaldef.•Alcohol/drug immunodeficiencyabuse•stress www.indiandentalacademy.com
  8. 8. CLINICAL FEATURES   Oral signsPunched - out , craterlike depressionsat the crest of the interdental papillaeSurface of craters covered by gray , psuedomembranous slough www.indiandentalacademy.com
  9. 9. Other clinical signsSpontaneous gingival hemorrhageFetid odorIncreased salivationwww.indiandentalacademy.com
  10. 10. Punched out interdental papillaLesions with progressive tissue destruction www.indiandentalacademy.com
  11. 11. Oral symptoms Lesions sensitive to touch Radiating , gnawing pain “Metallic” foul taste “Pasty” salivawww.indiandentalacademy.com
  12. 12. Systemic signs & symptoms High fever Lymphadenopathy Pulse rate Leukocytosis Loss of appetite www.indiandentalacademy.com
  13. 13. Clinical course Pindborg et al• Erosion of tip of papilla• Lesion extending to marginal gingiva• Lesion extending to attached gingiva• Exposure of bone www.indiandentalacademy.com
  14. 14. Horning and cohen• Stage 1 : necrosis of tip of papilla• Stage 2 : necrosis of entire papilla• Stage 3 : necrosis ext to gingival margin• Stage 4 : necrosis ext to attached gingiva• Stage 5 : necrosis ext to labial or buccal mucosa• Stage 6 : necrosis exposing alveolar bone• Stage 7 : necrosis perforating skin of cheek www.indiandentalacademy.com
  15. 15. Listgarten 1965 Bacterial zone Neutrophil rich zone Necrotic zone Spirochetal infiltration zonewww.indiandentalacademy.com
  16. 16. HistopathologySurface epithelium replaced by meshwork offibrin , necrotic epithelial cells , PMN’s etcConnective tissue is extremely hyperemic ,with engorged capillaries and denseinfiltration of PMN’s www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com
  18. 18. DIAGNOSIS Clinical findings Bacterial smear Biopsy specimenwww.indiandentalacademy.com
  19. 19. Clinical findings Gingival pain Ulceration Bleedingwww.indiandentalacademy.com
  20. 20. Bacterial smear Differential diagnosis of ANUG from Diphtheria Thrush ActinomycosisBiopsy specimen Differential diagnosis of ANUG from Tuberculosis Neoplastic disease www.indiandentalacademy.com
  21. 21. Differential diagnosis Herpetic gingivostomatitis Chronic periodontitis Desquamative gingivitis Diphtheritic & syphilitic lesions Agranulocytosis www.indiandentalacademy.com
  22. 22. THANK YOU FOR WATCHINGwww.indiandentalacademy.com www.indiandentalacademy.com

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