Diseases Of Periodontium Important Question And Answers

Diseases Of Periodontium Important Question And Answers

Diseases Of Periodontium

Question 1. Write a note on acute necrotizing ulcerative gingivitis.
Or
Write a short note on acute necrotizing ulcerative gingivitis.
Or
Write a short note on ANUG.

Answer. It is an endogenous oral infection which is characterized by the necrosis of the gingiva.

It is also called Trench mouth, Vincent’s infection, acute membranous gingivitis, and acute ulcerative gingivitis.

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Etiology

It is caused by the fusiform bacilli and spirochete.

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 stress and with an increase in adrenocortical secretion.
• Diseases like leukemia, syphilis, AIDS and gastrointestinal disturbances also lead to ANUG.

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Localized Predisposing Factors

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

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Clinical Features

• Acute necrotizing ulcerative gingivitis usually occurs among young and middle-aged adults, between the ages of 16 and 30 years and males suffer more often than females.
• Stressed professionals like army recruits tend to suffr more from the disease.
• Moreover, young children suffring 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.
• Patient have 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.

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Histopathology

• It involves both stratified squamous epithelium and underlying connective tissue.
• Surface epithelium is destroyed and is replaced by pseudomembranous meshwork of firin, necrotic epithelial cells, polymorphonuclear neutrophils and various microorganisms.
• Underlying connective tissue is hyperemic with numerous engorged capillaries and dense infiltration of polymorphonuclear neutrophils.
• Numerous plasma cells may appear in periphery of infiltrate.

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Treatment

• Conservative treatment is employed, i.e. superficial cleaning of oral cavity by chlorhexidine, diluted hydrogen peroxide or warm salt water. This is followed by scaling and polishing. Topical anesthetics are used to produce pain during procedure.
• Use of antibiotics is coupled with local treatment.