Signs and Symptoms
- Feeling of tightness around the teeth in early stages
- Severe gum pain
- Profuse gum bleeding
- Ulcerated interdental papillae with dead tissue
- Other possible signs: foul breath, bad taste, malaise, fever, cervical lymph node enlargement (rare), localized pain, more pronounced systemic reactions in children, rare complication of cancrum oris
Causes
- Mixed bacterial infection including anaerobes such as P. intermedia and Fusobacterium, and spirochetes such as Treponema
- Associated with diseases that compromise the immune system, such as HIV/AIDS
- Opportunistic infection on a background of impaired local or systemic host defenses
- Predisposing factors: smoking, psychological stress, malnutrition, immunosuppression
- Infection zones: bacterial, neutrophil rich, necrotic, spirochetal
Diagnosis
- Usually clinical diagnosis
- Smear for fusospirochaetal bacteria and leukocytes; occasional blood picture
- Differentiation from acute leukemia or herpetic stomatitis is important
Classification
- Necrotizing gingivitis is part of the spectrum of necrotizing periodontal diseases
- More advanced stages include necrotizing periodontitis, necrotizing stomatitis, and cancrum oris
- Necrotizing periodontitis involves attachment loss, gingiva, periodontal ligament, and alveolar ligament
- Necrotizing stomatitis involves tissue beyond the mucogingival junction
Treatment
- Irrigation and debridement of necrotic areas
- Oral hygiene instruction and use of mouth rinses
- Pain medication
- Oral antibiotics (e.g., metronidazole) if systemic involvement
- Proper management of associated systemic disorders
Necrotizing gingivitis (NG) is a common, non-contagious infection of the gums with sudden onset. The main features are painful, bleeding gums, and ulceration of inter-dental papillae (the sections of gum between adjacent teeth). This disease, along with necrotizing periodontitis (NP) and necrotizing stomatitis, is classified as a necrotizing periodontal disease, one of the three general types of gum disease caused by inflammation of the gums (periodontitis).
| Necrotizing gingivitis | |
|---|---|
| Other names | NG, Trench mouth |
 | |
| A fairly mild presentation of necrotizing gingivitis at the typical site on the gums of the anterior mandibular teeth. | |
| Specialty | Periodontology |
| Symptoms | pain, bad breath, fever, bleeding gums |
| Complications | Progression |
| Causes | bacterial infection by Prevotella intermedia, Treponema, Selenomonas, Fusobacterium spp, Spirochetes and compromised host immune response |
| Risk factors | HIV/AIDS, malnutrition, psychological stress, sleep deprivation, inadequate oral hygiene, pre-existing gingivitis, history of necrotizing periodontal disease, tobacco and alcohol use, youth, white ethnicity, orthodontics |
| Diagnostic method | Based on clinical findings (necrosis, ulcer of interdental papilla; gingival bleeding, pain, pseudomembrane formation, halitosis) |
| Differential diagnosis | herpetic gingivostomatitis, mucous membrane pemphigoid, pemphigus vulgaris, toothbrush abrasion |
| Prevention | oral hygiene |
| Treatment | debridement (dental), metronidazole |
The often severe gum pain that characterizes NG distinguishes it from the more common gingivitis or chronic periodontitis which is rarely painful. If NG is improperly treated or neglected, it may become chronic and/or recurrent. The causative organisms are mostly anaerobic bacteria, particularly Fusobacteriota and spirochete species.
Predisposing factors include poor oral hygiene, smoking, poor nutrition, psychological stress, and a weakened immune system. When the attachments of the teeth to the bone are involved, the term NP is used. Treatment of NG is by removal of dead gum tissue and antibiotics (usually metronidazole) in the acute phase, and improving oral hygiene to prevent recurrence. Although the condition has a rapid onset and is debilitating, it usually resolves quickly and does no serious harm. The informal name trench mouth arose during World War I as many soldiers developed the disease, probably because of the poor conditions and extreme psychological stress.
