necrotizing ulcerative gingivitis

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Related to fusospirochetal gingivitis: necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis, acute ulcerative gingivitis

gingivitis

 [jin″jĭ-vi´tis]
inflammation of the gums. Bleeding is a primary symptom, and other symptoms include swelling, redness, pain, and difficulty in chewing. Gingivitis can lead to the more serious disorder known as periodontitis. There are numerous causes, of which the primary one is pathogenic microorganisms in the crevices between the gums and the teeth. Other contributing factors are general poor health, host response to inflammation, hormonal imbalances, malnutrition, reactions to certain medications, irregular teeth, badly fitting fillings or dentures that irritate the gums, systemic disease, and infections such as herpetic gingivostomatitis. Gingivitis is best prevented by correct brushing and flossing of the teeth and proper oral hygiene. A good diet containing the necessary minerals and vitamins is also important. Vitamin deficiencies and anemia and other blood dyscrasias are often accompanied by gingivitis.
acute necrotizing ulcerative gingivitis (ANUG) (acute ulcerative gingivitis) necrotizing ulcerative gingivitis.
Dilantin gingivitis generalized hyperplasia of the gingiva, which may also rarely involve other areas of the oral mucosa, resulting in overgrowth of the fibrous tissue from the interaction of plaque accumulation with the anticonvulsive agent Dilantin (phenytoin).
necrotizing ulcerative gingivitis (NUG) an inflammatory destructive disease of the gingivae that has a sudden onset with periods of remission and exacerbation. It is marked by ulcers of the gingival papillae that become covered by sloughed tissue and circumscribed by linear erythema. Fetid breath, increased salivation, and spontaneous gingival hemorrhage are additional features. It may extend to other parts of the oral mucosa, with lesions involving the palate or pharynx (see also vincent's angina). The etiology is uncertain, but many authorities believe it is caused by a bacterial complex in the presence of predisposing factors such as preexisting gingival disease, smoking, severe stress, radical changes in eating or sleeping patterns, or nutritional deficiency. It has also been associated with immunodeficiency conditions such as infection with the human immunodeficiency virus (HIV). Although the disease often occurs in an epidemic pattern, it has not been shown to be contagious. Called also acute necrotizing ulcerative or acute ulcerative gingivitis.
pregnancy gingivitis any of various gingival changes ranging from gingivitis to the so-called pregnancy tumor.
Vincent's gingivitis necrotizing ulcerative gingivitis.

nec·ro·tiz·ing ul·cer·a·tive gin·gi·vi·tis (NUG),

an acute or recurrent gingivitis of young and middle-aged adults characterized clinically by gingival erythema and pain, fetid odor, necrosis, and sloughing of interdental papillae and marginal gingiva that gives rise to a gray pseudomembrane; fever, regional lymphadenopathy, and other systemic manifestations also may be present. A fusiform bacillus and Treponema vincentii can be isolated from the gingival tissues in large numbers and are thought to play a significant but poorly defined role in the pathogenesis.

necrotizing ulcerative gingivitis (NUG)

an inflammatory destructive disease of the gingivae that has a sudden onset with periods of remission and exacerbation. It is marked by ulcers of the gingival papillae that become covered by sloughed, necrotic tissue and circumscribed by linear erythema. Foul smelling breath, increased salivation, bone destruction, lymphadenopathy, and spontaneous gingival hemorrhage are additional features. It may extend to other parts of the oral mucosa, with lesions involving the palate or pharynx. It is usually associated with poor oral hygiene, immunosuppression, smoking, local trauma, poor nutritional status, inadequate sleep, or recent illness and psychological stress. It is most common in conditions in which there is crowding of the teeth and malnutrition. During World War I, this disease was nicknamed Trench Mouth. Although the disease often occurs in an epidemic pattern, it has not been shown to be contagious. Treatment includes chlorhexidine warm salt water rinses, mouthwashes, antibiotics, analgesics, and dental care to remove and disrupt bacterial flora. Also called Vincent's infection, trench mouth.

acute necrotising ulcerative gingivitis

A condition characterised by progressive necrosis of intraoral tissues and upper respiratory abscesses, which is seen in those with poor oral hygiene and suboptimal nutrition, often linked to herpes simplex and anaerobic flora—e.g., Fusobacterium spp, spirochetes.

Acute necrotizing ulcerative gingivitis (ANUG) appears to be the most appropriate for a polymicrobial (‘fusospirochetal’) gingival infection that most commonly occurs in a back-group of malnutrition, stress and poor oral hygiene; with time the ulcerating or ulceromembranous lesions may spread to the rest of the oral cavity.

It is also a more accurate term for the antiquated Vincent's angina, in which the infection is seated on the soft palate and tonsils.

The microbiological analysis of the lesions of ANUG, given that certain bacteria may cause acute (eg Streptococcus spp) and/or ulceromembranous (eg Corynebacterium diphtheriae) lesions.

“Trench mouth” is a coinage of World War I vintage which attributed ANUG to living in close quarters—i.e., “the trenches”.

Clinical findings
Pain, oedema, punched-out ulcers, pseudomembrane formation, halitosis.

DiffDx
Erythema multiforme, lichen planus, pemphigus, bullous pemphigoid.
 
Management
H2O2, antibiotics (e.g., tetracycline, if fever or lymphadenopathy), saline mouth rinse, local anaesthetics.

nec·ro·tiz·ing ul·cer·a·tive gin·gi·vi·tis

(NUG) (nek'rō-tīz-ing ŭl'sĕr-ă-tiv jin'ji-vī'tis)
An acute or recurrent gingivitis of young and middle-aged adults characterized clinically by gingival erythema and pain, fetid odor, and necrosis and sloughing of interdental papillae and marginal gingiva that give rise to a gray pseudomembrane; fever, regional lymphadenopathy, and other systemic manifestations also may be present. A fusiform bacillus and Treponema vincentii can be isolated from the gingival tissues in large numbers and are considered to play a significant but poorly defined role in the pathogenesis.
Synonym(s): fusospirochetal gingivitis, trench mouth, ulceromembranous gingivitis, Vincent disease, Vincent infection.

Vincent,

Henri, French physician, 1862-1950.
Vincent angina - an ulcerative infection of the oral soft tissues, including the tonsils and pharynx, caused by fusiform and spirochetal organisms.
Vincent bacillus
Vincent disease - Synonym(s): necrotizing ulcerative gingivitis
Vincent spirillum - the spirillum or spirochete found in association with Vincent bacillus.
Vincent tonsillitis - angina limited chiefly to the tonsils, caused by Vincent organisms (bacillus and spirillum).
Vincent white mycetoma - mycetoma caused by Actinomadura madurae and occurring in North Africa, India, Argentina, and Cuba.

gingivitis

a general term for inflammation of the gums, of which bleeding is one of the primary signs. Other signs include swelling, redness, pain and difficulty in chewing. There are numerous causes for this condition, and it can lead to a more serious disorder, periodontitis. One of the most common causes of gingivitis is the accumulation of food particles in the crevices between the gums and the teeth.

feline plasma cell gingivitis-pharyngitis, feline plasma cell-lymphocytic gingivitis-pharyngitis
a chronic inflammatory disease of the mouth in cats, characterized by proliferative and ulcerative lesions of the gums and palatine fossa. There is often anorexia and a fetid odor to the breath. The cause is unknown.
necrotizing ulcerative gingivitis
a gingival infection marked by redness and swelling, necrosis, pain, hemorrhage, a necrotic odor and often a pseudomembrane. Extension to the oral mucosa is called necrotizing ulcerative gingivostomatitis.

necrotizing

causing necrosis; exuding a brown to green, putrid discharge containing tissue debris.

necrotizing epithelioma, necrotizing calcifying epithelioma
necrotizing hepatopancreatitis
disease of shrimps caused by a small obligate intracellular unidentified bacterium; subacute to chronic syndrome with cumulative mortality of up to 90%.
necrotizing panniculitis
multifocal, erythematous, nonpruritic cutaneous lesions which ulcerate in the center and discharge seropurulent exudate; identifiable on histopathological examination.
necrotizing scleritis
a rare eye lesion, inflammatory proliferation of the anterior sclera, in dogs.
necrotizing ulcerative gingivitis
see necrotizing ulcerative gingivitis.
necrotizing vasculitis
important feature of the Arthus reaction; damage to the endothelium results from deposition of immune complexes in the vessel wall, usually on the basement membrane of the endothelium.