Interdental papillae are ulcerated with dead tissue. The papillary necrosis of NUG has been described as "punched out".Other signs and symptoms may be present, but not always. Foul breath. Bad taste (metallic taste).Malaise, fever and/or cervical lymph node enlargement are rare (unlike the typical features of herpetic stomatitis). Pain is fairly well localized to the affected areas. Systemic reactions may be more pronounced in children. Cancrum oris (noma) is a very rare complication, usually in debilitated children. Similar features but with more intense pain may be seen in necrotizing periodontitis in HIV/AIDS. Causes
Necrotizing periodontal disease is caused by a mixed bacterial infection that includes anaerobes such as P. intermedia and Fusobacterium as well as spirochetes, such as Treponema.ANUG may also be associated with diseases in which the immune system is compromised, including HIV/AIDS. ANUG is an opportunistic infection that occurs on a background of impaired local or systemic host defenses. The predisposing factors for ANUG are smoking, psychological stress, malnutrition, and immunosuppression. The following zones of infection have been described (superficial to deep): the bacterial zone, the neutrophil rich zone, the necrotic zone and the spirochetal zone. Diagnosis
Diagnosis is usually clinical. Smear for fusospirochaetal bacteria and leukocytes; blood picture occasionally. The important differentiation is with acute leukemia or herpetic stomatitis. Classification
Necrotizing gingivitis is part of a spectrum of disease termed necrotizing periodontal diseases. It is the most minor form of this spectrum, with more advanced stages being termed necrotizing periodontitis, necrotizing stomatitis, and the most extreme, cancrum oris.
Many other historical names for this condition (and Vincents angina) have occurred, including: "acute membranous gingivitis", "fusospirillary gingivitis", " fusospirillosis", "fusospirochetal gingivitis",  "phagedenic gingivitis", "Vincent stomatitis",  "Vincent gingivitis", and "Vincent infection".In the late 1980s-early 1990s, it was originally thought that some necrotizing periodontal diseases seen in severely affected AIDS patients 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; it also occurs with higher prevalence in association with other diseases in which the immune system is compromised. See also
Canker sore
Mouth ulcer

References


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