Periodontology Diagnosis - Necrotizing Periodontal Disease

Marin Contemporary Perio & Implant Concepts

Necrotizing periodontal diseases

Necrotizing periodontal diseases are a type of inflammatory periodontal or gum disease which are caused by bacteria. Most notably, the bacteria is of the fusobacteria and spirochaete species. The diseases often represent various levels of severity or stages of the same disease process, though this is not certain. These diseases typically have a sudden onset. As a result, the term “acute” is frequently added to the diagnosis. The mildest case on the spectrum of the disease is necrotizing ulcerative gingivitis (NUG), which is followed by the successively more severe conditions found with necrotizing ulcerative periodontitis (NUP), necrotizing stomatitis and lastly cancrum oris or noma, which is often fatal.

Necrotizing ulcerative gingivitis

Necrotizing ulcerative gingivitis (NUG), or simply necrotizing gingivitis (NG), is a common infection of the gums which is not contagious. Acute necrotizing ulcerative gingivitis (ANUG) is the acute presentation of NUG, which is the typical course the disease will take. When it is not properly treated, NUG can become chronic and recurrent. In developed countries, ANUG primarily occurs in young adults who have predisposition factor like psychological stress, sleep deprivation, poor oral hygiene, smoking, immunosuppression or malnutrition. In developing countries, ANUG most commonly occurs in malnourished children. Due to the shared predisposing factors in a population such as students during examinations or armed forces recruits, ANUG is known to occur in an epidemic-type pattern. This has led to the popular belief that ANUG is contagious, however, that is not the case. The main symptoms of NUG include painful, bleeding gums and ulceration and necrosis of the interdental papilla. Halitosis may also be present, in addition to cervical lymphadenitis or swollen lymph nodes in the neck and malaise. Treatment of the acute disease includes debridement and antibiotics, typically metronidazole. Poor oral hygiene and other predisposing factors should be corrected in order to prevent recurrence of the disease. ANUG is also known as trench mouth, as it was often found in the mouths of front line soldiers during World War I.

Necrotizing ulcerative periodontitis

Necrotizing ulcerative periodontitis (NUP), necrotizing periodontitis (NP) or acute necrotizing ulcerative periodontitis (ANUP) occurs when the infection leads to attachment loss. This destroys the ligaments which anchor teeth in their sockets. However, it only involves the gingiva, periodontal ligament and alveolar ligament. This spectrum of the diseases usually results in the loss of attachment. As a result, many ANUG diagnoses may be technically called NUP. Though ANUG is the term most often used. NUP may also be an extension of NUG into the periodontal ligaments. NUG and NUP are classified together under the general term of necrotizing periodontal diseases.

Necrotizing stomatitis

The progression of NUP into tissue beyond the mucogingival junction characterizes necrotizing stomatitis. Necrotizing stomatitis shares many features with cancrum oris.

Cancrum oris

Cancrum oris which is also called noma, is a necrotizing and destructive infection of the mouth and face. This condition typically occurs in malnourished children who live in developing countries. It may cause disfiguration and is often fatal. It is suggested that all cases of cancrum oris develop from a pre-existing NUG, however, this has not been confirmed. Most cases of NUG and NUP do not progress into the severe forms of the disease, even when they are not treated.

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