3. Definition
Microbial disease of the gingiva in the context
of an impaired host response.
Characterized by the death and sloughing of
gingival tissue
Presents with characteristics sign and
symptoms
4. Severe necrosis of the free gingival margin,
the crest of the gingiva and interdental
papilla
VsA. B
5. Also known as TRENCH MOUTH
because of its prevalence in the soldiers
working in trenches during WW1.
Vincent’s disease
Fusospirochetal gingivitis
6. H/o repeated remissions and exacerbation
Recur in previously treated Pt
Site?
- single
- group
- widespread.
Tissue destruction – longstanding disease
immunosuppressed pt
Bone loss occurs => NUP
7. Punched out
Crater like depressions at the crest of
interdental papillae, may extend up to
marginal gingiva
8. Surface of gingival craters is covered by a
gray pseudo membrane + necrotic tissue
debris
Age b/w 15 – 35yrs
Pain, interdental ulceration, and gingival
bleeding are the diagnostic triad
Interdental papillae - inflamed, edematous,
and hemorrhagic.
9. Spontaneous gingival hemorrhage after
slight stimulation
fetid odor and increased salivation
Progressively destroy the gingiva and
periodontal tissue
10. Constant radiating, gnawing pain
intensified by eating spicy or hot foods and
chewing
Metallic taste to saliva
• Extremely sensitive to touch
• Excessive amount of pasty saliva
11. Regional lymphadenopathy
Slight elevation of temp.
Severe case
- high fever
Leukocytosis
GI disturbance
Tachycardia
Loss of appetite
Sever in children
12. Given by pindborg et al.
Lesion starts as
1. Erosion of the tip of the interdental papilla
2. The lesion involving entire papilla &
marginal gingiva
3. Attached gingiva also involved
4. Exposure of the bone with complete loss of
interdental papilla, marginal gingiva, and
attached gingiva.
13. By Horning and Cohen
1. necrosis of the tip of the interdental papilla
2. necrosis of the entire papilla
3. necrosis extending to gingival margin(NUP)
4. necrosis extending to attached gingiva
14. 5. necrosis extending into buccal or labial
mucosa( necrotizing stomatitis)
6. necrosis exposing alveolar bone
7. necrosis perforating skin or cheek(noma)
15. Based on clinical findings of gingival pain,
ulceration, and bleeding
Microscopic examination of a bacterial smear or
biopsy specimen does not give specific picture.
Histologic picture greatly resembles marginal
gingivitis, periodontal pockets, pericoronitis or
primary herpetic gingivostomatitis
16. 1. alleviation of acute inflammation by
reducing microbial load & removal of necrotic
tissue
2. alleviation of genenralized sx – fever&
malaise
3. correction of systemic conditions that
contributes to the initiation or progression of
the gingival change
17. 1) first visit
Goal- reduce microbial load & remove
necrotic tissue
Complete evaluation of the pt
Treatment of acute lesion is primary goal.
Topical anesthetic applied
2-3min > gently swabbed. Remove pseudo
membrane and nonattached surface debris
cleaning with warm water
18. Ultrasonic scaling may be preferable, with
minimal pressure against the soft tissue
Sub gingival scaling and curettage are C/I at
this time
This may extend the infection to the deeper
tissues and cause bacteremia
20. No tobacco . Alcohol. Smoking
Rinse -mixture of 3% hydrogen peroxide and warm
water every 2hrs or twice daily with o.12%
chlorhexidine solution
Get adequate rest . Avoid excessive physical exertions
Confine tooth brushing to the removal of surface
debris with a bland dentifrice and an ultra soft brush
An analgesic such as NSAID – ibuprofen
21. 2 days after the first visit
Pt is evaluated for resolution of signs and Sx
Lesion - erythematous without a superficial
pseudo membrane
Shrinkage of the gingiva may expose
previously covered calculus, which is gently
removed.
Instructions are given same as previously
22. 5 days after the second visit
- pt is evaluated for resolution of Sx, and a
comprehensive plan for the management of
the pt’s periodontal conditions is formulated
Hydrogen peroxide rinse – discontinued
Chlorhexidine mouthwash – continued 2
or3 wks
Supportive therapy (e.g rest, appropriate
fluid intake, soft nutritious diet)
23. Repeat scaling & root planning (if required)
Reinstructed – plaque control measures
Pt counseling – nutrition and smoking
cessation
Appointments should be scheduled for t/t
1. Chronic gingivitis
2. Periodontal pockets
3. Pericoronal flap
4. Local irritants
Patient is reevaluated after 1 month.
24. 1. Contouring of gingiva as adjunctive
procedure
2. nutritional supplement
25. Periodontal plastic surgery
Reshaping the gingiva surgically
Indication?
Loss of interdental bone
Irregularly aligned teeth
Loss of entire papilla
Formation of a shelf like gingival margin
Why?
To restore normal gingival architecture
Esthetic concern