Goodlettsville Dental Services

Necrotizing Periodontal Diseases

Necrotizing periodontal disease is an infection of the gum tissue. If it presents as an acute infection of the gingiva without involvement of the other tissues of the periodontium, it can be subclassified as necrotizing ulcerative gingivitis (NUG). If the infection has progressed deeper into the periodontal tissues, it is subclassified as necrotizing ulcerative periodontitis (NUP).

Terminology

Necrotizing ulcerative gingivitis/periodontitis was originally known by a number of various other names, including “Plaut-Vincent angina,” “Vincent’s stomatitis,” “Vincent’s angina,” “Vincent’s infection,” “acute necrotizing ulcerative gingivitis” (ANUG) and “trench mouth.”

The last synonym may refer to situations during World War I when many soldiers suffered from the condition; there are, however, a number of other theories to the origin of this particular name. It was called Vincent’s angina after French physician Jean Hyacinthe Vincent (1862-1950).

Etiology

Necrotizing periodontal disease is caused by a bacterial infection that includes anaerobes such as P. intermedia and Fusobacterium as well as spirochetes, such as Borrelia and Treponema.

In the late 1980s-early 1990s, it was originally thought that necrotizing periodontal diseases were strictly a sequela of HIV, and it was even called HIV-associated periodontitis. It is now understood that its association with HIV/AIDS was due to the immunocompromised status of such patients, and it occurs with higher prevalence in association with other diseases in which the immune system is compromised.

Signs and symptoms

Clinical features of necrotizing periodontal disease may include:

• necrosis and/or ulceration of the interdental papillae (“punched-out papillae”) or gingival margin
• pseudomembranous formation
• painful, bright red marginal gingiva that bleed upon gentle manipulation
• halitosis

Coincident factors may include heavy smoking and poor nutrition, especially for those presenting with necrotizing ulcerative periodontitis.

Treatment

Treatment includes irrigation and debridement of necrotic areas (areas of dead and/or dying gum tissue), oral hygiene instruction and the uses of mouth rinses and pain medication. As these diseases are often associated with systemic medical issues, proper management of the systemic disorders is appropriate.

Prognosis

Untreated, the infection may lead to rapid destruction of the periodontium and can spread, as necrotizing stomatitis, into neighbouring tissues in the cheeks, lips or the bones of the jaw. As stated, the condition can occur and be especially dangerous in people with weakened immune systems.

Notable people affected

• author William Styron
• football player Ernie Davis
• actress Marilyn Monroe