ACUTE ACUTE GINGIVAL GINGIVAL

INFECTIONSINFECTIONSbyby

Dr. Marcel HallareDr. Marcel Hallare

NECROTIZING NECROTIZING ULCERATIVE GINGIVITIS ULCERATIVE GINGIVITIS

(NUG)(NUG)

Most often occurs as an Most often occurs as an acuteacute disease disease Often undergoes a diminution in Often undergoes a diminution in

severity, leading to a subacute stage severity, leading to a subacute stage with milder clinical symptomswith milder clinical symptoms

May subside spontaneously without May subside spontaneously without treatmenttreatment

Such patients generally have a history Such patients generally have a history of repeated remission and exacerbationsof repeated remission and exacerbations

NECROTIZING ULCERATIVE NECROTIZING ULCERATIVE PERIDONTITIS PERIDONTITIS Involves tissue destruction of Involves tissue destruction of

supporting structures with bone losssupporting structures with bone loss

HistoryHistory Occurs with sudden onsetOccurs with sudden onset Follows an episode of debilitation or Follows an episode of debilitation or

acute respiratory tract infectionacute respiratory tract infection Change in living habits, protracted Change in living habits, protracted

work without adequate rest, and work without adequate rest, and psychologic stress are frequent features psychologic stress are frequent features of the patient’s historyof the patient’s history

Oral SignsOral Signs Characteristic lesions are Characteristic lesions are punched out, punched out,

craterlike depressions at the crest of the craterlike depressions at the crest of the interdental papillaeinterdental papillae, extending to the marginal , extending to the marginal gingiva and rarely to the attached gingiva and gingiva and rarely to the attached gingiva and oral mucosaoral mucosa

Surface of gingival craters is covered by a Surface of gingival craters is covered by a gray, gray, pseudomembranous slough, demarcated from pseudomembranous slough, demarcated from the remainder of the gingival mucosa by a the remainder of the gingival mucosa by a pronounced linear erythemapronounced linear erythema

Spontaneous gingival hemorrhage or Spontaneous gingival hemorrhage or pronounced bleeding on the slightest pronounced bleeding on the slightest stimulationstimulation

Fetor odor and increased salivation are evidentFetor odor and increased salivation are evident

May occur in otherwise disease-free mouthsMay occur in otherwise disease-free mouths Condition does not usually lead to Condition does not usually lead to

periodontal pocket formationperiodontal pocket formation

Oral SymptomsOral Symptoms The lesions are extremely sensitive to touch, The lesions are extremely sensitive to touch,

and the patient often complains of a and the patient often complains of a constant radiating, gnawing pain constant radiating, gnawing pain that is that is intensified by eating spicy or hot foods and intensified by eating spicy or hot foods and chewingchewing

There is a foul metallic taste, and the There is a foul metallic taste, and the patient is conscious of an excessive amount patient is conscious of an excessive amount of “pasty” salivaof “pasty” saliva

Extraoral and Systemic Signs and Extraoral and Systemic Signs and SymptomsSymptoms Patients are usually ambulatoryPatients are usually ambulatory Presence of local lymphadenopathyPresence of local lymphadenopathy Slight elevation in temperature are Slight elevation in temperature are

common featurescommon features

DiagnosisDiagnosis Based on clinical findings of gingival Based on clinical findings of gingival

pain, ulceration, and bleedingpain, ulceration, and bleeding Bacterial smear is not necessaryBacterial smear is not necessary

EtiologyEtiology

Local Predisposing FactorsLocal Predisposing Factors Preexisting gingivitis, injury to the gingiva, and Preexisting gingivitis, injury to the gingiva, and

smoking are important predisposing factorssmoking are important predisposing factors Appearing in an otherwise disease-free mouthAppearing in an otherwise disease-free mouth Occurring superimposed on preexisting chronic Occurring superimposed on preexisting chronic

gingival disease and periodontal pocketsgingival disease and periodontal pockets Areas of gingiva traumatized by opposing teeth Areas of gingiva traumatized by opposing teeth

in malocclusion, such as the palatal surface in malocclusion, such as the palatal surface behind the maxillary incisors and the labial behind the maxillary incisors and the labial gingival surface of the mandibular incisors are gingival surface of the mandibular incisors are frequent sites of NUG frequent sites of NUG

Systemic Predisposing FactorsSystemic Predisposing Factors NUG is often superimposed on gingival NUG is often superimposed on gingival

alterations caused by severe systemic alterations caused by severe systemic diseasedisease Nutritional DeficiencyNutritional Deficiency

Poor diet is a predisposing factor to NUGPoor diet is a predisposing factor to NUG Nutritional deficiency (e.g., Vitamin C, Vitamin B2) Nutritional deficiency (e.g., Vitamin C, Vitamin B2)

accentuates the severity of the pathologic changeaccentuates the severity of the pathologic change Debilitating DiseaseDebilitating Disease

Systemic disturbances are chromic diseases such as Systemic disturbances are chromic diseases such as syphilis and cancer, severe gastrointestinal disorders syphilis and cancer, severe gastrointestinal disorders such as ulcerative colitis, blood dyscrasias such as such as ulcerative colitis, blood dyscrasias such as leukemia sans anemia, and acquired leukemia sans anemia, and acquired immunodeficiency syndrome (AIDS)immunodeficiency syndrome (AIDS)

Nutritional deficiency resulting from debilitating Nutritional deficiency resulting from debilitating disease may be an additional predisposing factordisease may be an additional predisposing factor

Before Treatment After Before Treatment After TreatmentTreatment

Psychosomatic FactorsPsychosomatic Factors Psychologic factors appear to be important in the etiology of Psychologic factors appear to be important in the etiology of

NUGNUG The disease often occurs associated with stress situations The disease often occurs associated with stress situations

(induction into the armed forces or school examinations)(induction into the armed forces or school examinations) Psychological disturbances as well as increased Psychological disturbances as well as increased

adrenocortical secretion are common in patients with the adrenocortical secretion are common in patients with the disease disease

PRIMARY HERPETIC GINGIVOSTOMATITISPRIMARY HERPETIC GINGIVOSTOMATITIS Infection of the oral cavity caused by the Infection of the oral cavity caused by the

herpes simplex virus type 1 (HSV-1)herpes simplex virus type 1 (HSV-1) Occurs most often in infants and children Occurs most often in infants and children

younger than 6 years of age but seen in younger than 6 years of age but seen in adolescents and adults as welladolescents and adults as well

Occurs with equal frequency between male and Occurs with equal frequency between male and female patientsfemale patients

After primary infection the virus ascends through After primary infection the virus ascends through sensory and autonomic nerves and persists in sensory and autonomic nerves and persists in neuronal ganglia that innervate the site as latent neuronal ganglia that innervate the site as latent HSVHSV

Clinical featuresClinical featuresOral SignsOral Signs Discrete spherical gray vesicles which may occur Discrete spherical gray vesicles which may occur

on the gingiva, labial and buccal mucosa, soft on the gingiva, labial and buccal mucosa, soft palate, pharynx, sublingual mucosa, and tonguepalate, pharynx, sublingual mucosa, and tongue

After 24 hours the vesicles rupture and form After 24 hours the vesicles rupture and form painful, small ulcers with a red, elevated, halo-painful, small ulcers with a red, elevated, halo-like margin and a depressed, yellowish or grayish-like margin and a depressed, yellowish or grayish-white central portionwhite central portion

PRIMARY HERPETIC PRIMARY HERPETIC GINGIVOSTOMATITISGINGIVOSTOMATITIS

Oral SymptomsOral Symptoms Generalized “soreness” of the oral cavity Generalized “soreness” of the oral cavity

which interferes with eating and drinkingwhich interferes with eating and drinking

Extraoral and Systemic Signs and Extraoral and Systemic Signs and SymptomsSymptoms

Cervical adenitis, fever as high as 38.30C to Cervical adenitis, fever as high as 38.30C to 40.60C and generalized malaise are 40.60C and generalized malaise are commoncommon

HistoryHistory The condition often occurs during and The condition often occurs during and

immediately after an episode of such febrile immediately after an episode of such febrile diseases as pneumonia, meningitis, diseases as pneumonia, meningitis, influenza, and typhoidinfluenza, and typhoid

DiagnosisDiagnosis Established from the patient’s history Established from the patient’s history

and clinical findingsand clinical findings Material may be submitted to the Material may be submitted to the

laboratory fro confirmatory testlaboratory fro confirmatory test

CommunicabilityCommunicability It is contagiousIt is contagious Does not ordinarily recur unless Does not ordinarily recur unless

immunity is destroyed by debilitating immunity is destroyed by debilitating systemic diseasesystemic disease

PERICORONITISPERICORONITIS

Inflammation of the Inflammation of the gingiva in relation gingiva in relation to the crown of an to the crown of an incompletely incompletely erupted tootherupted tooth

Occurs most often Occurs most often in the mandibular in the mandibular third molar areathird molar area

May be acute, May be acute, subacute, or subacute, or chronicchronic

Clinical FeaturesClinical Features Partially erupted mandibular third molar is the Partially erupted mandibular third molar is the

most common site of pericoronitismost common site of pericoronitis The space between the crown of the tooth and the The space between the crown of the tooth and the

overlying gingival flap is an ideal area for the overlying gingival flap is an ideal area for the accumulation of food debris and bacterial growthaccumulation of food debris and bacterial growth

The inflammatory fluid and cellular exudates The inflammatory fluid and cellular exudates increase the bulk of the flap, which then may increase the bulk of the flap, which then may interfere with complete closure of the jawsinterfere with complete closure of the jaws

Resultant clinical picture is that of a markedly Resultant clinical picture is that of a markedly red, swollen, suppurating lesion that is exquisitely red, swollen, suppurating lesion that is exquisitely ender, with radiating pain to the ears, throat, the ender, with radiating pain to the ears, throat, the floor of the mouthfloor of the mouth

The patient is extremely uncomfortable because The patient is extremely uncomfortable because of the foul taste and an inability to close the jaws, of the foul taste and an inability to close the jaws, in addition to the painin addition to the pain

PericoronitisPericoronitis