Acute Necrotising Ulcerative Gingivitis

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  • 1. ACUTE NECROTISING ULCERATIVE GINGIVITIS Dr 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. EPIDEMIOLOGY
    • 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. ETIOLOGY
    • 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 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. REFERENCE
    • 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)