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.
Toxic anterior segment syndrome is an acute, sterile anterior segment inflammation following generally uneventful cataract and anterior segment surgery.One of the main factors in differentiating toxic anterior segment syndrome from an infectious endophthalmitis is the rapid onset. Most patients with toxic anterior segment syndrome will develop symptoms within 12 to 24 hours of the surgery. Common findings on anterior segment slit lamp examination include increased cell and flare with associated fibrin and possible hypopyon formation. Patients may show signs of diffuse corneal edema, and they may also show signs of iris atrophy with pupillary abnormalities and eventual increased intraocular pressure. It is important to differentiate sterile postoperative inflammation from infectious endophthalmitis because the treatments of these patients are markedly different. Patients with toxic anterior segment syndrome will often respond rapidly to treatment with topical corticosteroids, while infectious endophthalmitis must be treated with antibiotics. It is important that the patients be evaluated often to ensure that the inflammation is clearing and that the patients intraocular pressure is under control. The clearing of the inflammation and eventual patient outcome is related to the severity of the toxic insult at the time of surgery. Most patients reported to date are in the category of a moderate toxic inflammation. Toxic anterior segment syndrome may be related to problems with any irrigating solution or other solution placed in the patients eye during surgery, including balanced salt solution or anything added to solutions.