Necrotizing gingivostomatitis is an inflammatory condition affecting the gingiva and mouth that is caused by fusiform bacteria and spirochetes. It is characterized by painful, red gingiva with crater-like sores between teeth, bleeding gums, bad breath, and fever. Examination of affected tissue shows many bacteria and white blood cells. Histologically, there is gingival ulceration and necrosis with an inflammatory cell infiltrate. Treatment involves cleaning the mouth with antiseptics followed by scaling and antibiotics to resolve the infection.

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.

13. 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.

14. 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.

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