Acute necrotising ulcerative gingivitis is a rare condition characterized by necrosis of the gingiva and interdental papillae. It frequently occurs during times of stress and poor oral hygiene. The condition is caused by fusiform bacillus and Borrelia vincentii bacteria. Clinically, the gingiva becomes painful and develops punched-out ulcers. It can spread to other oral tissues and rarely the skin, causing further complications.

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)