Acute necrotising ulcerative gingivitis , ANUG /certified fixed orthodontic courses by Indian dental academy
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Necrotizing ulcerative gingivitis (NUG), also known as trench mouth, is an infectious disease of the gums causing bleeding, ulcers, and pain. It was first described in ancient Greece and differentiated from other conditions in the 18th century. It is caused by an infection of fusiform-spirochete bacteria like P. intermedia and Fusobacterium. Risk factors include nutritional deficiencies, drug or alcohol abuse, stress, and immunodeficiency. Clinically, it presents as crater-like ulcers on the gums with gray pseudomembranes and bleeding. Diagnosis is based on clinical signs and symptoms as well as bacterial smears and biopsy findings.
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Acute necrotising ulcerative gingivitis , ANUG /certified fixed orthodontic courses by Indian dental academy
- 1. INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
- 2. Necrotizing ulcerative gingivitis is an infectious disease of the gingiva causing gingival bleeding, gingival ulceration and pain. www.indiandentalacademy.com
- 3. History Necrotizing ulcerative gingivitis had been recognized in the 4th century BC by Xenophon, who mentioned that Greek soldiers were affected with “sore mouth and foul smelling breath”. In 1778, Hunter described the clinical features of this disease and differentiated it from scurvy and chronic periodontitis. www.indiandentalacademy.com
- 4. Synonyms Vincent’s disease Fusospirochetal gingivitis Trench mouth Acute ulcerative gingivitis Necrotizing gingivitis www.indiandentalacademy.com
- 5. ETIOLOGY Role of bacteria • A specific infectious disease should be associated with a specific etiology. The bacterial etiology of Necrotizing ulcerative gingivitis provides one of our strongest examples of a primarily bacterial etiology in a periodontal disease. Plaut in 1894 and Vincent in 1896 first proposed this bacterial etiology. • They both reported that fusiform-spirochete bacteria flora were associated with lesions of NUG. www.indiandentalacademy.com
- 6. Loesche et al Constant flora Variable flora • P. intermedia Heterogeneous • Fusobacterium array of bacteria • Treponema www.indiandentalacademy.com
- 7. Role of host response •Nutritional def. •Alcohol/drug immunodeficiency abuse •stress www.indiandentalacademy.com
- 8. CLINICAL FEATURES Oral signs Punched - out , craterlike depressions at the crest of the interdental papillae Surface of craters covered by gray , psuedomembranous slough www.indiandentalacademy.com
- 9. Other clinical signs Spontaneous gingival hemorrhage Fetid odor Increased salivation www.indiandentalacademy.com
- 10. Punched out interdental papilla Lesions with progressive tissue destruction www.indiandentalacademy.com
- 11. Oral symptoms Lesions sensitive to touch Radiating , gnawing pain “Metallic” foul taste “Pasty” saliva www.indiandentalacademy.com
- 12. Systemic signs & symptoms High fever Lymphadenopathy Pulse rate Leukocytosis Loss of appetite www.indiandentalacademy.com
- 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. 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. Listgarten 1965 Bacterial zone Neutrophil rich zone Necrotic zone Spirochetal infiltration zone www.indiandentalacademy.com
- 16. Histopathology Surface epithelium replaced by meshwork of fibrin , necrotic epithelial cells , PMN’s etc Connective tissue is extremely hyperemic , with engorged capillaries and dense infiltration of PMN’s www.indiandentalacademy.com
- 18. DIAGNOSIS Clinical findings Bacterial smear Biopsy specimen www.indiandentalacademy.com
- 19. Clinical findings Gingival pain Ulceration Bleeding www.indiandentalacademy.com
- 20. Bacterial smear Differential diagnosis of ANUG from Diphtheria Thrush Actinomycosis Biopsy specimen Differential diagnosis of ANUG from Tuberculosis Neoplastic disease www.indiandentalacademy.com
- 21. Differential diagnosis Herpetic gingivostomatitis Chronic periodontitis Desquamative gingivitis Diphtheritic & syphilitic lesions Agranulocytosis www.indiandentalacademy.com
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