Periodontal diseases are often classified according to their severity.Gingivitis is an infection that occurs when bacteria invade soft tissues, bone, and other places. They range from mild gingivitis, to more severe periodontitis, and finally acute necrotizing ulcerative gingivitis, which can be life threatening.Infection begins when the body's immune system is overwhelmed. It is the interaction between host and bacteria, mostly fusospirochetes.In necrotizing condition, punchedout gingival margin, pseudomembrane that peels off, leaving row areas. Mariginal gingiva affects, other oral tissue rarely.
Acute necrotizing ulcerative gingivitis is a rapidly progressive ulceration typically starting at the tips of the interdental papilla, spreading along the gingival margins and going on to acute destruction of the periodontal tissue.
ANUG is characterized by:
- Sudden onset
- Precede and episode of debilitating disease like respiratory tract infection.
As a result, they often developed trench mouth, a severe form of gingivitis that causes painful, infected, bleeding gums and ulcerations.Trench mouth is also known as Vincent's stomatitis and acute necrotizing ulcerative gingivitis (ANUG). Fortunately, regular brushing and flossing, professional tooth cleaning and antibiotics can usually clear up the infection from trench mouth. And practicing good oral hygiene can help prevent future problems.
Oral symptoms:
- Sensitive to touch.
- Constant radiating, gnawing pain, intensified by hot food or mastication.
- Metallic foul taste.
- Excessive Pasty saliva.
- Feeling of 'wooden pegs'.
Oral signs:
- Charter shaped or punched out ulcer, that involved primarily tips of interdental papilla, the labial or lingual margin or both, but never across attached gingiva.
- The edge of ulcer is defined by erythema and edema.
- Crater is covered by a gray, pseudomenbranous slough, removal of slough causes bleeding.
- Fetid odor and increased salivation.
- Spontaneous gingival bleeding upon slightest stimuli.
- Involvement may be a single tooth, a group of teeth or throughout the mouth, rare in edentulous patient.
Extra oral signs/symptoms:
(i) Mild to moderate case:
-Local lymphadenopathy.
-Slight increase in temperature,
(ii) Severs form:
- Increase fever
- Increase pulse rate,
- Leukocytosis
- Loss of appetite
- Lassitude,
- Insomnia
- Constipation
- Headache
- Mental disease
(iii) Very severe from:
The squeal may be-
- Noma or gangrenous stomatitis.
- Fusospiracetal meningitis.
- Peritonitis,
- Toximia
- Pulmonary infection.
- Fatal brain absess.
It's a mistake to think that a disease of the mouth isn't serious enough to cause harm to the rest of your health. Acute necrotizing ulcerative gingivitis can become so bad that it is difficult for the patient to eat or swallow.Relatively uncommon in children. It's pretty obvious as to why that's a bad idea. Prompt treatment is essential to correct the problem and allow the sufferer relief from this mouth disease.
# You will notice that it is painful to brush your teeth because the bristles will keep rubbing up against the gums which become very sore due to the intense infection
# Serious case of halitosis will either begin or worsen when necrotizing ulcerative gingivitis is present
# There will be lesions on the gums that are also called canker or mouth sores
Histopathology:
1. Inflammation of marginal gingiva involving both stratified squamus epithelium and underlying connective tissue.
2. Surface epithelium is destroyed and replace by a pseudomembranous meshwork of fibrin, necrotic cells, polymorphonuclear cells and various type of micro-organism.
3.The underlying connective tissue is hyperemic with infiltration of PMN's. Numerus plasma cells may appear the periphery of the infiltration.
4. At the immediate border, the epithelium is edematous and individual cells exhibit degeneration.
Causes:
A. Microorganisms:
i) Fusiform bacilli mainly, e. g. Fusobacterium specis (F. nucleatum)
ii) Spirochetes.
iii) Filamentus organism, e. g. Borrelia vencenti.
B) Predesposing factors:
a) Local factors:
i) Pre existing gingivitis.
ii) Chemical irritants e. g. smoking
b)Systemic factors:
i) Nutritional deficiency-due to
-deficient diet.
-debilitating disease.
-vitamine deficiency especially vit 'B' complex and vit 'C
ii) Debilitating disease:
- Metalic intoxication
- Severe G. I. T. disease eg, ulcerative colitis.
- Cachexia due to chronic disease e. g. Syphilis, Cancer
- Blood dyscaresias -e. g. Leukemias.
c)Psychosomatic:
- Anxiety
- Depression
- Stress.
Acute Necrotizing Ulcerative Gingivitis appears with stress. College students can get it during finals and people breaking up can get it. The onset of some medical conditions such as HIV infection can cause it. Regardless of the cause, it should be treated and the cause found. People who smoke, have poor nutrition and who have dental infections are susceptible.
Clinical course of disease:
(i) May subside spontaneously if history of recurrence
(ii) If untreated may cause-
- Progressive destruction of periodontium.
- Denudation of root
- Systemic complications.
Treatment:
Three major aspects of treatment are:
i) Physical (oral hygine) measures:
* Removal of calculus by scaling.
* Home care-Regular tooth brushing with appropiate method.
* Poor hygiene that allows plaque buildup is the primary preventable cause of ANUG, but additional factors such as smoking and compromised immune system function caused by other chronic or acute disease. Patients with ANUG typically demonstrate a reduced ability to cope with psychological and emotional stress.
* A gray, bacteria-infested film will form on your teeth and gums which will require advanced gingivitis treatment to effectively remove.
2. Drugs:
Metronidazole (for mixed infection) 200 mg, 3times daily for 3 days, after meal.
3. Use of oxidising agents:
Rinsing with-
- H2O2 directly to the gingiva:
- Chlorhexidine mouth wash.
Advantage of Metronidzole:
i) Rapidly acting
ii) Not sensitinzing like penicillin,
iii. Not prone to promote superinfection.
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