Acute gingival infrections

Necrotizing Ulcerative Gingivitis
(NUG)

Trench Mouth.
Vincent Infection.
Acute Ulceromenbranous
Gingivitis.
Fusospirochetal
Gingivitis
Acute Ulcerative Gingivitis

Necrotizing Ulcerative
Gingivitis (NUG)

It is a painful, inflammatory destructive disease
which affect marginal and papillary gingiva
and less frequently the attached gingiva.

Classification

 Acute  A single tooth
 Subacute  A group of the teeth
 May be wide-spread
throughout the
mouth.

Oral Signs
Oral Signs
 Craterlike depressions at the crest of the
interdental papilla

Sudden onset

 Sometimes the lesions are denuded of
the surface pseudomembrane, exposing
the gingival margin which is red, shiny
and hemorrhagic.

Other Signs
Other Signs
Other Signs
 Gingival hemorrhage

 Fetid odor (Halitosis).

 Increased of salivation.

 The disease can occur in otherwise disease-
free mouth or can be superimposed on
chronic gingivitis or periodontal pockets.

Oral Symptoms
Oral Symptoms

 The gingiva is extremely sensitive to
touch.
 Constant, radiating, gnawing pain.

 Metallic unpleasant taste.

 Excessive amount of “pasty” saliva.

Extraoral and Systemic Signs and Symptoms

 Patients are usually ambulatory and have a
minimum of systemic complications.

 Local lymphadenotathy and slight elevation
of the temperature.

 Insomnia, fatigue, anorexia,
gastrointestinal disorders, headache and
mental depression (sometimes).

Etiology
Etiology

Bacterial Flora

 Predominantly spirochetes and fusiform
bacilli.

Local Predisposing Systemic Predisposing
Factors Factors

 Preexisting chronical
gingivitis and  Nutritional
periodontal pocket. Deficiencies.
 Predominance of
Spirochetes, Bacteroides  Debilitating Diseases:
and Fusiform bacteria in
the plaque.
 Psychosomatic Factors
 Plaque retentive areas
and areas of the gingiva
traumatized.
 Smoking

Diagnosis
Based on clinical findings of gingiva.

Epidemiology and Prevalence
 An epidemic pattern.
 Occurs at all age.
 It is not common in children.

Communicability
It has not been shown to be communicable or contagious.

Treatment
Treatment
. First Visit.
 History of the Chief Complaint.

 Extraoral and Intraoral Examination.

 Isolated with cotton rolls and dried.

 Apply topical anesthesia

 The areas are swabbed by a cotton pellet with
normal saline or hydrogen peroxide 3%.

Treatment
Treatment
 Remove supra gingival calculus.

 All procedures such as extractions or periodontal
surgery are postponed until the patient has been
symptom free for a period of 4 weeks.

 The patient is instructed to rinse the mouth every
2 hours with a glassful of an equal mixture of
warm water and 3% hydrogen peroxide or twice
daily rinse with 0.12% chlorhexidine.

Treatment
Treatment

 Antibiotic treatment in moderate or severe NUG
and local lymphadenopathy or other systemic
symptoms (penicillin, 500mg orally every 6 hours
or erythromycin in the same way).

 Metronidazole (500 mg twice times daily for 7
days).

Treatment
Treatment
Instructions to the patient

1.Avoid tobacco, alcohol and condiments.

2. Avoid excessive physical exertion.

3. Confine tooth brushing to the removal of
surface debris with a bland dentifrice.

Second Visit: (1 or 2 days ago)

Treatment
Treatment
 Scaling, if sensitivity permits.
 Shrinkage of the gingival may expose the
previously covered calculus, which is
gently removed.
 The instructions to the patient are the
same.

Third visit: (1 or 2 days after the second)

Treatment
Treatment
 Scaling and root planning are repeated.
 The patient is instructed in plaque control
procedures.
 The hydrogen peroxide rinses are
discontinued.
 Maintain chlorhexidine rinses for 2 or 3
weeks.

Subsequent Visits
 The tooth surfaces in the involved areas are
scaled and smoothed.
 Plaque control by the patient is checked and
corrected if is necessary.
 Comprehensive treatment of the patient's
chronic periodontal problem should start
(chronic gingivitis, periodontal pockets, etc)

Additional Treatment (Gingivectomy)

Primary Herpetic Gingivostomatitis

Is an infection of the oral cavity
caused by herpes simplex virus type 1 (HSV -1)

Oral Signs
Oral Signs
 Diffuse, erythematous and shiny gingiva and the
adjacent oral mucosa.

 Varying degrees of edema and gingival bleeding.

 Presence of discrete, spherical gray vesicles which
may occur on the gingiva, labial and buccal
mucosa, soft palate, pharynx, sublingual mucosa
and tongue.

Oral Signs
Oral Signs

 A painful, small
ulcers with red,
elevated, halolike
margin and a
depressed, yellowish
or gray-wite central
portion

Oral Signs
Oral Signs
 Occasionally may occur without overt
vesiculation.
 The course of the disease is limited from 7 to
10 days.
 The diffuse gingival edema and erythema may
persist for several days.
 Scarring does not occurs in the areas of healed
ulcerations.

Oral Symptoms
Oral Symptoms
 Generalized “soreness” of the oral cavity, which
interferes with eating and drinking.

 The rupture vesicles are the focal sites of pain.


 Cervical adenitis, fever as high 101 to
1050 F (38.3 to 40.60 C) and general
malaise are common.

 History:
Recent acute infection is a common feature of the
history of the patient.

 Diagnosis:
The diagnosis is usually established from the
patient’s history and the clinical findings.

 Communicability:
This disease is contagious. Most adults have
developed immunity to HSV as the result of infection
during childhood.

Treatment
Treatment It is directed to alleviates
the symptoms

 Topical local anesthetic .

 Orabase compounded with high-potency topical steroids
(e.g., clobetasol).

 Clorhexidine mouthwash.

 Acyclovir preparations (antiviral agents) may be
prescribe for topical and systemic.

The patient should be informed that the disease is contagious
at certain stages such as when vesicles are present. All individuals
exposed to an infected patient should take precautions.

Supportive Treatment
 Panadol or nonestoroidal anti-
inflammatory agent for the relieve of pain.
 Copious fluid intake.
 Systemic antibiotic therapy for the
management of toxic systemic
complications in severe cases. No
penicillin (may aggravate the herpetic
lesions).

RECURRENT APHTOUS
STOMATITIS

It is a disorder characterized by recurring painful ulcers
It is a disorder characterized by recurring painful ulcers
in the oral mucosa, which vary in shape, number and size.
in the oral mucosa, which vary in shape, number and size.

 RAS affects 20% of the general population.

 Can affects both sex, women are more susceptible.

 It is classified according to clinical characteristics as
Minor ulcers, Major ulcers and Herpetiform ulcers.

ETIOLOGY
 Hereditary factors.
 Immunologic Disorders.
 Psychosomatic Disorders.
 Gastrointestinal Diseases.
 Trauma.
 Endocrine Factors.
 Allergy.
 Hematological and Nutritional Deficiencies.
 Smoking.

 Minor ulcers, comprise more than 80% of RAS
cases, are less than 1 cm in diameter and heal
without scars.

 Major ulcers are over 1 cm in diameter, take longer
to heal and often scar on healing.

 Herpetiform ulcers are considered a distinct clinical
entity that manifests as recurrent crops of dozens of
small ulcers (2- 3 mm) throughout the oral mucosa.

TREATMENT
Topical Therapy
 Medication prescribed to treat RAS should relate to
the severity of the disease.

 In mild cases, use of topical coating agents such
as Orabase or Zilactin is appropriate.

 Pain relief can be obtained with the use of a topical
anesthetic agent, such as benzocaine in Orabase.

 In more severe cases, the use of a high
potency topical steroid.

 Other topical preparations that have been
shown to decrease the healing time of minor
RAS lesions include topical tetracycline

Gingival Abscess

Is a lesion of the marginal or interdental gingiva, usually
produced by an impacted foreign object.

CLINICAL CHARACTERISTICS
 Sudden onset, painful.

 Red, rounded swelling localized to the papilla
and marginal gingiva with smooth and shinny
surface.

 The adjacent teeth may be sensible during
percussion.

Treatment
Treatment

 Under topical and local infiltrative anesthesia,
the fluctuant area of the lesion is incised with #
15 blade, and the incision is gently widened to
permit the drainage. The area is cleansed with
warm water and covered with a gauze pad.

Treatment
Treatment
 After bleeding stops, the patient is dismissed
for 24 hours and instructed to rinse every 2
hours with a glassful of warm water.

 When the patient returns, the lesion generally
is reduced in size and free of symptoms.
 Apply topical anesthesia and make the scaling
of the involved area.

Bibliography
 Carranza´s. Clinical Periodontology. 9th
ed. 2003. pg:15-55.
 Gururaja R. Textbook of Periodontology.
2nd ed. pg: 6.
 Klaus H. Color Atlas of Dental Medicine.
Periodontology. Vol 1. 1989. pg: 1- 10.

Acute gingival infrections

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