Necrotizing ulcerative gingivitis (NUG) is a typical form of periodontal diseases. It has an acute clinical presentation with the distinctive characteristics of rapid. MEDIDAS NO FARMACOLÓGICAS. Gingivitis ulcerativa necrosante o. Angina de Vincent (GUNA) en pacientes inmunodeprimidos,. VIH, leucemia, neutropenia. Aka: Acute Necrotizing Ulcerative Gingivitis, ANUG, Trench Mouth, Vincent’s . Gingivite ulcéreuse nécrosante, Maladie de Vincent, Gingivite ulcéro-nécrotique, .

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Necrotizing ulcerative gingivitis NUG is a typical form of periodontal diseases. It has an acute clinical presentation with the distinctive characteristics of rapid onset of interdental gingival necrosis, gingival pain, bleeding, and halitosis. Systemic symptoms such as lymphadenopathy and malaise could be also found. There are various ilceronecrosante factors such as stress, nutritional deficiencies, and immune system dysfunctions, especially, HIV infection that seems to play a major role in the pathogenesis of NUG.

Acute Necrotizing Ulcerative Gingivitis

The treatment of NUG is organized in successive stages: Moreover, finally, maintenance phase that allows ulceronecfosante outcomes. This case report describes the diagnosis approach and the conservative management with a good outcome of NUG in a year-old male patient with no systemic disease and probable mechanism of pathogenesis of two predisposing factors involved.

Necrotizing ulcerative gingivitis NUG is a distinct and specific form of periodontal diseases. It has an acute clinical presentation with the distinctive characteristics of rapid onset of gingival pain, interdental gingival necrosis, and bleeding.

NUG has been recognized for centuries. It has been ulceroonecrosante many names: Vincent’s disease, fusospirochetal gingivitis, trench mouth, acute ulcerative gingivitis, necrotizing gingivitis, and acute NUG.

NUG was classically seen among military personnel during World War I, presumably due to multiple risk factors including poor oral hygiene, intense psychological stress, and malnutrition. Since then, it has appeared at much lower rates in the general population. However, it increased later on in patients with an immunocompromised condition, especially HIV-infected patients.

Actually and according to the recent data, the prevalence rate of NUG varies over a wide range from 6. Other factors such as tobacco smoking,[ 3 ] preexisting gingivitis, and trauma have been reported as predisposing factors of NUG. NUG can heal without clinical sequelae. In this case report, we present a diagnostic, therapeutic approach and successful outcomes of ulceronecrosantd localized form of ulcerative necrotizing gingivitis.

A year-old male patient, with painful gingival gingiviti evolving since 4 days, consulted urgently the Department of Periodontology, Faculty of Dentistry, University of Hassan II Morocco, in March The patient reported that he had taken some medicines such as antiviral treatment acyclovir and anti-inflammatory drugs diclofenac.

The patient reported subjective malaise, chills, ulceroecrosante difficulty in eating due to the intensive pain. We also noted during physical examination a thin, febrile, ulderonecrosante male, but no adenopathy was noted on cervical ganglionic area examination.

The clinical examination revealed a halitosis, erythematous, and swelling gingiva localized at the buccal side of the upper central, the upper, gingibitis lower lateral incisors and canines. A suitable probing was done seven days after emergency treatment, neither pockets ulceronerosante attachment loss were found, especially on the upper anterior teeth. X-ray examination showed a generalized periodontal ligament enlargement, a passive eruption of the right maxillary canine, an idiopathic root resorption of the lower incisors, and a marginal alveolar bone loss in the lower central incisors which might be due to occlusal trauma [ Figure 4 ].


Laboratory HIV test was done, gngivitis the result was negative [ Figure 5 ].

The diagnosis was established a NUG. The treatment was undertaken urgently: A 10 volumes diluted hydrogen peroxide was gently applied to the necrotic pseudomembranous lesions using sterile swabs in conjunction with suitable ultrasonic supragingival debridement.

The patient was prescribed oral antibiotic mg metronidazole every 8 h for 7 days ulceronecrrosante oral mouth rinse 0. The gingiva state was evaluated 2 days [ Figure 6 ] and 7 days after [ Figure 7 ] the clinical examination showed a major improvement in symptoms with almost complete gingivotis of the ulcerated pseudomembranous areas and reduction of erythema and swelling, and then, a subgingival debridement was conducted.

In the context of global periodontal approach, gingivectomy was done in the right maxillary canine 23 [ Figure 8 ] 2 months after healing. The patient ulceronexrosante seen regularly, once a month. A favorable evolution was noted without any tissue sequelae but rather with the obtention of a symmetrical and homogeneous architecture of the healing gingiva [ Figure 9 ].

NUG was classified in several classification systems: Its presence is probably related to the severity of the disease ulcerronecrosante it is usually observed in advanced cases.

Necrotizing Ulcerative Gingivitis

The typically clinical appearance of NUG is related to its histopathological aspect. Four gingivitid layers have been described from the most superficial to the deepest layers of the lesion Listgarten et al. The microbiota composition associated with NUG and found in lesion layers includes Treponema spp.

That might explain why the patient took antiviral drugs.

enfermedades periodontales necrosantes by nadia Garcia on Prezi

The predisposing factors play a main role on NUG by the downregulation of the host immune response facilitating bacterial pathogenicity, these factors include: The proposed mechanisms to explain the association between psychological stress and NUG are based on reductions of the gingival microcirculation and salivary flow, increases in adrenocortical secretions which are associated with an alteration in the function of polymorphonuclear leukocytes and lymphocytes. Moreover, finally, supportive or maintenance phase.

Treatment of the acute phase has two main objectives of therapy: Metronidazole mg, every 8 h may be an appropriate first choice of drug because it is active against strict anaerobes. Oral hygiene instructions and motivation should be enforced. Existing predisposing local factors, such as overhanging restorations and interdental open spaces, should be carefully evaluated and treated.

Systemic predisposing factors including smoking, adequate sleep, and reduction of stress should be controlled and taken into consideration. Moreover, the main goal of this phase is complying with the oral hygiene practices and controlling the predisposing factors. Controversially, a quick healing and spectacular papilla regeneration was achieved leading to an esthetic final result.

A gingivectomy on 23 was done just to have a more esthetic symmetric gingival line.

Furthermore, Patient compliance is satisfactory, he has a good plaque control and respects the appointments of controls and still on maintenance phase. The patient compliance was a positive factor in the favorable evolution of the clinical outcome.

NUG is a specific acute periodontal disease. The diagnosis seems evident according to the three typical clinical features as papilla necrosis, bleeding, and pain on the one hand and the identification of risk factors that alter the host response on the other hand.


Treatment should be organized on successive ulceronecgosante, and the acute phase treatment should be provided immediately to prevent sequelae and craters in soft tissues that will lead to new relapses. Finally, a good compliance with the oral hygiene practices and maintenance do guarantee better and stable outcomes. The authors would like to thank the patient in this report for help and his good compliance till today. Each author listed on the manuscript has significantly contributed and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.

National Center for Biotechnology InformationU. Ulcwronecrosante List Contemp Clin Dent v.

Author information Copyright and License information Disclaimer. Abstract Necrotizing ulcerative gingivitis NUG is a typical form of periodontal diseases. Diagnosisnecrotizing periodontal diseasesnecrotizing ulceonecrosante gingivitistreatment. Introduction Necrotizing ulcerative gingivitis NUG is a distinct and specific form of periodontal diseases.

Case Report A year-old male patient, with painful gingival inflammation evolving since 4 days, consulted urgently the Department of Periodontology, Ulderonecrosante of Dentistry, University of Hassan II Morocco, tingivitis March He had a poor plaque control without any parafunction and was a nonsmoker. He had no other significant medical history or known allergies. He had also gingiviits stressful job; he worked as a model and was under a severe diet.

Open in a separate window. Discussion NUG was classified in several classification systems: The bacterial area with a superficial fibrous mesh composed of degenerated epithelial cells, leukocytes, cellular rests, and a wide variety of bacterial cells, including rods, gingivihis, and spirochetes. The neutrophil-rich zone composed of a high number of leukocytes, especially neutrophils, and numerous spirochetes of different sizes and other bacterial morphotypes located between the host cells.

The necrotic zone, containing disintegrated cells, together with medium- and large-size spirochetes and fusiform bacteria. The spirochetal infiltration zone, where the tissue components are adequately preserved but are infiltrated with large- and medium-size spirochetes. Other bacterial morphotypes are not found. Conclusion NUG is a specific acute periodontal disease.

Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgment The authors would like to thank the patient in this report for help and his good compliance till today. Acute necrotising ulcerative gingivitis in an immunocompromised young adult. BMJ Case Rep Epidemiology of necrotizing ulcerative gingival lesions in ginglvitis. Atout RN, Todescan S. Managing patients with necrotizing ulcerative gingivitis.

J Can Dent Assoc. Enfermedades periodontales ne- crosantes. Acute necrotizing ulcerative gingivitis: A survey of cases. The epidemiology, etiology, and pathophysiology of acute necrotizing ulcerative gingivitis associated with malnutrition. J Contemp Dent Pract. The bacteriology of acute necrotizing ulcerative gingivitis. Stress and periodontal disease: Support Center Support Center. Please review our privacy policy.