ACUTE GINGIVAL INFECTIONS

by Dr. Marcel Hallare

NECROTIZING ULCERATIVE GINGIVITIS (NUG)

Most often occurs as an acute disease Often undergoes a diminution in severity, leading to a subacute stage with milder clinical symptoms May subside spontaneously without treatment Such patients generally have a history of repeated remission and exacerbations

NECROTIZING ULCERATIVE PERIDONTITIS

Involves

tissue destruction of supporting structures with bone loss

History Occurs with sudden onset Follows an episode of debilitation or acute respiratory tract infection Change in living habits, protracted work without adequate rest, and psychologic stress are frequent features of the patients history

Oral Signs
Characteristic

lesions are punched out, craterlike depressions at the crest of the interdental papillae, extending to the marginal gingiva and rarely to the attached gingiva and oral mucosa Surface of gingival craters is covered by a gray, pseudomembranous slough, demarcated from the remainder of the gingival mucosa by a pronounced linear erythema Spontaneous gingival hemorrhage or pronounced bleeding on the slightest stimulation Fetor odor and increased salivation are evident

 May

occur in otherwise disease-free mouths Condition does not usually lead to periodontal pocket formation

Oral Symptoms
The

lesions are extremely sensitive to touch, and the patient often complains of a constant radiating, gnawing pain that is intensified by eating spicy or hot foods and chewing There is a foul metallic taste, and the patient is conscious of an excessive amount of pasty saliva

Extraoral and Systemic Signs and Symptoms

Patients

are usually ambulatory Presence of local lymphadenopathy Slight elevation in temperature are common features

Diagnosis
Based

on clinical findings of gingival pain, ulceration, and bleeding Bacterial smear is not necessary

Etiology Local Predisposing Factors

Preexisting

gingivitis, injury to the gingiva, and smoking are important predisposing factors Appearing in an otherwise disease-free mouth Occurring superimposed on preexisting chronic gingival disease and periodontal pockets Areas of gingiva traumatized by opposing teeth in malocclusion, such as the palatal surface behind the maxillary incisors and the labial gingival surface of the mandibular incisors are frequent sites of NUG

Systemic Predisposing Factors

NUG

is often superimposed on gingival alterations caused by severe systemic disease

Nutritional

Deficiency

Poor diet is a predisposing factor to NUG Nutritional deficiency (e.g., Vitamin C, Vitamin B2) accentuates the severity of the pathologic change
Debilitating

Disease

Systemic disturbances are chromic diseases such as syphilis and cancer, severe gastrointestinal disorders such as ulcerative colitis, blood dyscrasias such as leukemia sans anemia, and acquired immunodeficiency syndrome (AIDS) Nutritional deficiency resulting from debilitating disease may be an additional predisposing factor

Before Treatment

After Treatment

 Psychosomatic

Factors

Psychologic factors appear to be important in the etiology of NUG The disease often occurs associated with stress situations (induction into the armed forces or school examinations) Psychological disturbances as well as increased adrenocortical secretion are common in patients with the disease

PRIMARY HERPETIC GINGIVOSTOMATITIS

Infection

of the oral cavity caused by the herpes simplex virus type 1 (HSV-1) Occurs most often in infants and children younger than 6 years of age but seen in adolescents and adults as well

Occurs with equal frequency between male and female patients After primary infection the virus ascends through sensory and autonomic nerves and persists in neuronal ganglia that innervate the site as latent HSV

Clinical features
Oral Signs Discrete spherical gray vesicles which may occur on the gingiva, labial and buccal mucosa, soft palate, pharynx, sublingual mucosa, and tongue After 24 hours the vesicles rupture and form painful, small ulcers with a red, elevated, halo-like margin and a depressed, yellowish or grayish-white central portion

PRIMARY HERPETIC GINGIVOSTOMATITIS

Oral Symptoms Generalized soreness of the oral cavity which interferes with eating and drinking Extraoral and Systemic Signs and Symptoms Cervical adenitis, fever as high as 38.30C to 40.60C and generalized malaise are common History The condition often occurs during and immediately after an episode of such febrile diseases as pneumonia, meningitis, influenza, and typhoid

Diagnosis Established from the patients history and clinical findings Material may be submitted to the laboratory fro confirmatory test Communicability It is contagious Does not ordinarily recur unless immunity is destroyed by debilitating systemic disease

PERICORONITIS
Inflammation

of the gingiva in relation to the crown of an incompletely erupted tooth Occurs most often in the mandibular third molar area May be acute, subacute, or chronic

Clinical Features

Partially erupted mandibular third molar is the most common site of pericoronitis The space between the crown of the tooth and the overlying gingival flap is an ideal area for the accumulation of food debris and bacterial growth The inflammatory fluid and cellular exudates increase the bulk of the flap, which then may interfere with complete closure of the jaws Resultant clinical picture is that of a markedly red, swollen, suppurating lesion that is exquisitely ender, with radiating pain to the ears, throat, the floor of the mouth The patient is extremely uncomfortable because of the foul taste and an inability to close the jaws, in addition to the pain

Pericoronitis