Understanding Acute Necrotizing Ulcerative Gingivitis: From Etiology to Cure

Understanding Acute Necrotizing Ulcerative Gingivitis: From Etiology to Cure

Question. Describe in detail necrotizing ulcerative gingivitis.

Answer. It is an endogenous oral infection characterized by necrosis of the gingiva. It is also called trench mouth.

acute necrotizing ulcerative gingivitis

Etiopathogenesis

Proliferation of anaerobic fusiform bacteria and spirochaetes results in ANUG. Infection mostly occurs in the presence of psychological stress. Stress related corticosteroid hormones are thought to alter T4/T8 lymphocyte ratios and may cause the decreased neutrophilic chemotaxis and phagocytic response seen in patients with ANUG. Stress-related epinephrine may result in localized ischemia, which predisposes the gingiva to ANUG.

“Understanding acute necrotizing ulcerative gingivitis through FAQs: Q&A explained”

The following are the predisposing factors for acute necrotizing Ulcerative Gingivitis:

• Systemic predisposing factors
• Local predisposing factors

Systemic Predisposing Factors

• Malnutrition: This may lead to acute necrotizing ulcerative gingivitis
• Nutritional deficiency: Deficiency of Vitamin C, Vitamin B1, and Vitamin B2 leads to the exaggeration of pathologic changes caused by fusospirochetal bacteria.
• Psychosomatic conditions: Disease is associated with the stress and with increment in adrenocortical secretion.
• Diseases like leukemia, syphilis, AIDS and gastrointestinal disturbances also leads to ANUG.

“Importance of studying acute necrotizing ulcerative gingivitis for better diagnostic outcomes: Questions explained”

Localized Predisposing Factors

• Marginal gingivitis
• Poor oral hygiene
• Faulty dental restorations
• Deep periodontal pockets
• Tobacco smoke

“Role of poor oral hygiene in causing acute necrotizing ulcerative gingivitis: Questions answered”

Clinical Features

• Acute necrotizing ulcerative gingivitis usually occurs among young and middle aged adults, between the ages of 16 and 30 years and males suffr more often than females.
• Stressed professionals, like army recruits, tend to suffer more from the disease.
• Moreover, young children suffering from malnutrition are also prone to the disease.
• Initially, the gingiva becomes red, edematous, hemorrhagic and painful.
• Later, on, a sharply demarcated “punched-out” crater-like erosion of the inter­dental papillae occurs.
• Gingiva is often covered by a gray “pseudomembrane”with accumulation of necrotic tissue debris.
• The patient has pronounced spontaneous bleeding tendency, exquisite pain and an extremely unpleasant fetid odor in the mouth.
• Patients often develop headache, fever, malaise and lymphadenopathy of the affected area.
• Often there is difficulty in taking food due to increased salivation and a metallic taste in the mouth.
• When the necrotizing process leads to the development of periodontitis with loss of epithelial attachment the condition is called necrotizing ulcerative periodontitis.
• When the necrotizing process of ANUG extends further through the oral mucosa and reaches to the extraoral skin surface, the condition is called ‘noma’ or cancrum oris.

“Common challenges in diagnosing acute necrotizing ulcerative gingivitis effectively: FAQs provided”

Investigations

Investigations are associated with the testing of fusiform bacilli and spirochaetes:

• Spirochetes and fusiform bacilli are demonstrated in stained smears of exudates from the lesion on microscopic examination. The spirochete T.pallidum is visible on dark ground microscopy.
• Direct fluorescent antibody test is done for the detection of the spirochete T. pallidum
• Enzyme immunoassays are also done to detect for spirochetes present in ANUG.
• Antibody tests, i.e. detection of specifi IgM antibody is helpful in detection of Treponema.

“Factors influencing success with acute necrotizing ulcerative gingivitis treatment: Q&A”

Differential Diagnosis

• Benign mucous pemphigoid: In this as compared to ANUG,it is seen in elderly people and no necrosis is evident.
• Pemphigoid lichen planus: It does not show any acute course,no foul breadth is observed.
• Pemphigus: It present a very regular histology. Seen in older people.
• Syphilitic gingivitis: Lesion is seen on gingiva and it does not get spread to adjacent gingiva.
• Streptococcal gingivostomatitis: Diffuse erythema is seen on posterior parts of oral mucosal lining and no necrosis is evident.
• Gingivostomatitis by candida: Covering of white membrane is seen which can be removed by scrapping. On laboratory investigation, the membrane reveals of candida.

Complications

Patients affected by ANUG develop systemic complications such as:

• Pulse rate get increases
• High fever
• Loss of appetite
• Generalized lassitude.

“Steps to explain causes of acute necrotizing ulcerative gingivitis: Bacterial vs viral infections: Q&A guide”

Treatment

• The involved areas are isolated with cottn rolls and dried.
  A topical anesthetic is applied and after 2 to 3 minutes, areas are gently swabbed with a cottn pellet to remove pseudomembrane. After the area is cleaned with warm water, superficial calculus is removed.
• Patient is told to rinse the mouth every 2 hours with glassful of an equal mixture of warm water and 3% hydrogen peroxide. Twice daily rinsing with 0.12% chlorhexidine are effective.
• Penicillin V 250 or 500 mg, 6 hourly, or erythromycin 250 or 500 mg, 6 hourly are given.
• Scaling is performed, if sensitivity permits. After disease process is diminished, complete gingival curettage and root planing is done.
• Supportive treatment consists of copious fluid consumption and administration of nutritional supplements.