This document discusses Necrotizing Ulcerative Gingivitis (NUG), also known as trench mouth. It defines NUG as a microbial disease of the gingiva caused by an impaired host response. Key clinical features include necrosis of gingival tissue and pain. Diagnosis is based on these clinical findings and microscopic examination. Management involves reducing the microbial load, removing necrotic tissue, treating any systemic conditions, and supportive periodontal therapy. Prognosis is generally good with treatment but recurrence is possible without ongoing maintenance of oral hygiene.

1. Keumyi Chin

2.  Introduction
 Clinical Feature
 Diagnosis
 Management
 Prognosis
 Referred books

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

19.  Amoxicillin 500mg O 6hr 10days
 Erythromycin 500mg 6hr
 Metronidazole 500mg twice daily 7days

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

26.  Carranza’s clinical periodontology vol. 1
( pg. 133 -138)
 Carranza’s clinical periodontology vol.2
( pg. 607- 610)
 Textbook of periodontology and oral
implantology (pg. 167-171)