This document summarizes and describes several acute gingival lesions: acute necrotizing ulcerative gingivitis (ANUG), acute herpetic gingivostomatitis (AHGS), and acute pericoronitis. It covers the etiology, clinical features, signs and symptoms, diagnosis, differential diagnosis and treatment for each condition. The lesions are characterized by inflammation and ulceration of the gingiva with symptoms ranging from pain and fever to spontaneous bleeding. Treatment involves local and systemic approaches like antibiotics, antivirals, analgesics and antiseptics depending on the specific condition.

1. Acute gingival lesion
Acute gingival lesions are
(i) Acute Necrotizing Ulcerative Gingivitis
(ANUG)
(ii) Acute Herpetic Gingivostomatitis (AHGS)
(iii) Acute pericronitis

2. ANUG
Def:
an inflammatory destructive disease
of the gingiva which presents
characteristic signs and symptoms

3. OTHER TERMS USED
 VINCENT’S INFECTION
 TRENCH MOUTH
 VINCENT’S STOMATITIS
 PSEUDOMEMBRANOUS ANGINA

4. ETIOLOGY
(i) Systemic factors
(ii) Local factors

5. SYSTEMIC FACTORS
A-Psychological stress
B-Debilitating disease
C-Nutritional deficiency

6. LOCAL FACTORS
A-Smoking
B-Local trauma
C-Role of bacteria

7. CLASSIFICATION
(i) ACUTE
(ii) SUBACUTE
(iii) RECURRENT
(iv) CHRONIC

8. CLINICAL FEATURE
* SYMPTOMS
1-ORAL
2-EXTRAORAL
*SIGNS
1-SYSTEMIC SIGNS
2-ORAL SIGNS

9. SYSTEMIC SIGNS
(a) High fever
(b) Increased pulse rate
(c) Leukocytosis
(d) Loss of appetite
(e) General lassitude
(f) Insomnia , constipation

10. ORAL SIGNS
 Crater like depression at the crest of the
inter dental papilla extending to the
marginal gingiva
 Spontaneous gingival hemorrhage
 Fetor odor
 Increased salivation

11. DIFFERENTIAL DIAGNOSIS
(i) Acute necrotic gingivostomatitis
(ii) Chronic destructive periodontal disease
(iii) Gonococcal stomatitis
(iv) AIDS
(v) Ulcerative gingivitis in leukemia
(vi) Chronic desquamative gingivitis
(vii) Agranulocytosis

12. TREATMENT
1- AMBULATORY
Pt will have less toxic symptoms and will
walk in to the clinic by him self
2- NON-AMBULATORY
Pt will be bed ridden

13. TREATMENT
1- LOCAL
2- SYSTEMIC

14. ACUTE HERPATIC
GINGIVOSTOMATITIS
ETIOLOGY
HSV type I

15. CF
EXTRAORAL FEATURE
-fever
-lassitude
-lymphadenitis
-malaise
-headache

16. INTRAORAL FEATURE
-Generalized gingival inflammation is one of the earliest oral signs of acute
herpetic gingivostomatitis
- It’s characterized by :
- Diffuse ,erythematuos shiny involvement of gingiva and oral mucosa
- The Giniva is edematuos and easy bleeds on slightest provocation
- Gingival inflammation is followed by appearance of :
. Grayish or yellow vesicle on the gingiva ,labial and buccal mucosa ,soft
palate, pharynx, floor of the mouth and tongue
- After 24 hours –> vesicle rupture forming small painful ulcers
. The ulcers are one to two millimeter in diameter with elevated halo like
margin and yellowish or greyish white central portion
. Frank ulcer covered by pseudomembran and surrounds by erythema.

17. DIAGNOSIS
-CLINICAL PICTURE
-CONFIRMATORY TEST

18. TREATMENT
- Anesthetic mouth wash
- Antibiotic
- Antiseptic solution
- Analgesic
- Antiviral drugs

19. DIFFRENTIAL DIAGNOSIS
- Erythema Multiforme
- Steven’s Johnson's syndrome
- Aphthous Ulcers
- Agranulocytosis
- Acute Periocronitis

20. PERICRONITIS
Def
It is the inflammation of the gingiva in
relation to the crown of an incompletely
erupted tooth occurs mostly in the
mandibular third molars

21. TYPES
• ACUTE
• SUBACUTE
• CHRONIC

22. - The pt is extremely uncomfortable
- In ability to close the jaw
- Swelling of cheek
- Systemic toxic manifestations :
-fever
-leukocytosis
-malaise

23. COMPLICATION
- Localized pericoronal abscess
- Difficulty in swallowing when the
inflammation spread
- Involvement of the lymph node
- Ludwig's angina

24. ACUT GINGIVAL ABCESS
- It is a sudden acute and painful condition
- Involve only marginal and inter dental
papilla
- The abscess area will be bright red, shiny
in colure
- The duration of abscess is short (24-48
hours)

25. C/F
- The flap is red
- Swollen
- Ulcerated from the inner surface
- Tender
- Radiating pain to the ear , throat and floor
of the mouth
- Foul test

26. - Some times there will be oozing exudate
i.e. pus from gingival margin
- on percussion on adjacent teeth there will
be sensitivity or tenderness

27. ETIOLOGY
Foreign bodies (e.g. tooth brush bristles ,
food particles )

28. TREATMENT
- Drainage of the fluctuant abscess
- Antiseptic solution
- Mouthwash
- Anti inflammatory drugs
- Antibiotic

29. ACUTE CANDIDASES
Predisposing factor
- Prolonged use of antibiotic
- Immunosuppressive disease

30. CLINICALLY
- Elevated white plaque surface (coagulated
milk)
- Bleeding surface underneath

31. CONFIRMATORY TEST

32. TREATMENT
- Nystatin
- Ampholericin B