What Is Acute Necrotizing Ulcerative Gingivitis?

1. Microorganisms: Clostridium and spirochaesis that already exist in the oral cavity, but due to the host's susceptibility and resistance decreased, a large increase in bacteria or virulence enhances the invasion of tissues, directly or indirectly causing non-specificity in the superficial layer of gum epithelium and connective tissue Acute necrotic inflammation.

Ouyang Xiangying	(Chief physician)	Department of Periodontology, Peking University Stomatological Hospital
Kang Jun	(Chief physician)	Department of Periodontology, Peking University Stomatological Hospital
Shi Dong	(Deputy Chief Physician)	Department of Periodontology, Peking University Stomatological Hospital

Necrotizing ulcerative gingivitis is a necrotic inflammation confined to the gums. It is an acute attack at most, so it is also called acute necrotizing ulcerative gingivitis. Because a large number of Clostridium and Borrelia are found in the lesions of patients with this disease, It is called "Clostridium Treponema gingivitis". During World War I, the disease was prevalent among front-line soldiers, so it was also known as the trench trench. Necrotizing ulcerative gingivitis occurs mainly in young adults, poorer regions and countries with malnutrition or children with infectious diseases (such as measles, malaria, chicken pox). At present, the disease is rare in economically developed countries, and it has been significantly reduced in China.

Western Medicine Name: Necrotizing ulcerative gingivitis
Other name: Acute necrotizing ulcerative gingivitis, clostridial spiritis gingivitis, trench trench
Affiliated Department: Department of Physiology-Stomatology

Disease site: Gums
The main symptoms: Severe pain, bleeding, rancid odor
Main cause: Microbes, plaque gingivitis or periodontitis, nervousness, low immune function, smoking
Multiple groups: Young adults, malnourished or infectious children

Causes of necrotizing ulcerative gingivitis

1. Microorganisms: Clostridium and spirochaesis that already exist in the oral cavity, but due to the host's susceptibility and resistance decreased, a large increase in bacteria or virulence enhances the invasion of tissues, directly or indirectly causing non-specificity of the gum epithelium and connective tissue Acute necrotic inflammation.

2. Existing plaque gingivitis or periodontitis: Gingivitis and periodontitis caused by poor oral hygiene and existing bacteria are common risk factors for necrotizing ulcerative gingivitis. Blind bags in deep periodontal pockets or pericoronitis are suitable for the proliferation of spirochaetes and anaerobic bacteria. When there are traumas or systemic factors in some local tissues, bacteria multiply and invade gum tissues, necrotic ulcerative gingivitis .

3. Mental stress: This disease often occurs in students during the examination period and patients with mental stress, excessive fatigue, and lack of sleep. Endocrine changes caused by mental stress may reduce local resistance. And mental stress may cause patients to neglect oral hygiene and increase smoking.

4. Immune dysfunction: Some children who are malnourished (especially vitamin C deficiency) or suffer from wasting diseases, such as tumors, acute infectious diseases, blood diseases, and immunocompromised patients, are prone to this disease. People with AIDS often have similar damage to this disease.

5. Smoking: It is reported that most patients with necrotizing ulcerative gingivitis have a large history of smoking. ^[1]

Clinical manifestations of necrotizing ulcerative gingivitis

1. It often occurs in young adults and is more common in male smokers. In underdeveloped countries or poor areas, it can also occur in children with extreme malnutrition or acute infectious diseases such as measles and black fever.

2. The onset of this disease is acute, the gums are severely painful, or there is a feeling of tooth spreading or pain.

3. Spontaneous bleeding from the gums and bleeding from slight contact. There is blood on the pillow in the morning and bloody smell in the mouth.

4. Due to tissue necrosis, there is a special smell of corruption.

5. Severe patients may have submandibular lymphadenopathy and tenderness, increased saliva, and low fever.

6. Gingival nipples and marginal gingival necrosis. At the beginning, the gingival nipples are congested and edema, and necrotic ulcers occur on the tops of individual interdental nipples, covered with gray-white necrosis. The center of the gingival papilla is concave like a crater, and the lesion quickly expands along the gingival edge to the adjacent teeth, making the gingival edge like worm-eaten. After removing the necrotic tissue, the nipple and the gingival gingival are in a straight line like a knife-like shape. Increased secretion.

If the acute stage is not treated in time and the patient's resistance is low, the necrosis can also affect the lip and buccal mucosa corresponding to gum lesions, and become necrotizing gingivostomatitis. If the disease progresses quickly and is not treated in time, it can also lead to small or large alveolar bone necrosis. This condition is especially seen in immunodeficiency patients (including AIDS patients). People with extremely low body resistance can also be co-infected with Percobacterium perfringens, which can cause necrosis of the cheek tissue and even perforation, which is called walking horse flounder. At this time, the lesions developed rapidly, and the patient had symptoms of systemic poisoning and even death. At present, horseshoe crab has basically disappeared in our country.

Necrotizing ulcerative gingivitis can be converted to chronic necrotizing gingivitis if it is not completely treated or recurrent in the acute phase. Its main clinical manifestations are severe damage and even disappearance of the interdental papilla. The gingival height at the nipple is lower than the height of the gingival margin, showing an anti-wavy shape. There are tartar and soft dirt on the tooth surface, and the gums are generally free of necrosis. ^[2] ^[1]

Histopathological manifestations of necrotizing ulcerative gingivitis

The histopathological manifestations of necrotizing ulcerative gingivitis are nonspecific acute necrotizing inflammation of the gums, involving lesions of the epithelium and underlying connective tissue.

Diagnosis and differentiation of necrotizing ulcerative gingivitis

Diagnosis of necrotizing ulcerative gingivitis

1. Occurs in people with mental stress and smokers, which are more common in young people.

2. The onset is relatively rapid, and the lesions develop rapidly. Often within a few days to a week, it appears as "crater" -like necrosis of the gingival nipple, and worm-like necrosis of the gingival margin.

3. Spontaneous pain and tenderness of the gums.

4, accompanied by automatic bleeding gums.

5. Corruptive bad breath and false film formation.

6. Others: thick saliva, enlarged lymph nodes, low fever, fatigue, etc.

7. A large number of Clostridium and Borrelia can be seen on the necrotic smear by Wright staining.

The diagnosis of chronic phase is mainly based on recurrent gingival necrosis, painful bleeding, disappearance of gingival nipples, bad breath, etc. No special bacteria were found on the bacterial smear test.

Differential diagnosis of necrotizing ulcerative gingivitis

1. Differentiation from plaque gingivitis. Plaque gingivitis is a chronic process with no necrotic lesions and is generally not painful. Gingival bleeding is mainly non-spontaneous bleeding.

2. Differentiation from herpes stomatitis. Herpes stomatitis is a viral infection, which mostly occurs in young children. Gum congestion generally affects all gums, and often invades other parts of the mouth and surrounding spring tissue. Typical lesions are clusters of vesicles that form small ulcers or ulcers that fuse with each other after ulceration, but without necrosis.

3. Identification with oral manifestations of patients with acute leukemia. Patients with acute leukemia may have spontaneous bleeding and halitosis, anemia and failure manifested throughout the body, and blood tests can help diagnose the underlying disease, leukemia.

4. Identification with oral manifestations of AIDS patients. Due to the low immune function, AIDS patients often cause opportunistic infections caused by various bacteria, which can be combined with necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis, the latter are mostly found in AIDS patients. ^[3]

Necrotizing Ulcerative Gingivitis Treatment

1. Acute phase: "Tooth washing", gently remove large tartar.

2. Scrub and rinse with 3% hydrogen peroxide solution to remove necrotic tissue.

3. Severe cases also require oral anti-anaerobic drugs such as metronidazole or tinidazole. Metronidazole is 0.2 g three times a day, and the condition can be controlled for three days.

4. Supportive therapies such as vitamin C can also be given throughout the body, with adequate rest.

5. Oral hygiene is also very important. Replace your toothbrush and keep your mouth clean to prevent recurrence. And quit smoking.

6. After the acute phase, periodontal treatment of chronic gingivitis or periodontitis that already exists. All irritation factors such as plaque and calculus are removed by cleaning and scraping. Periodontal surgery is performed to help control local inflammation and prevent recurrence. ^[2] ^[1]

Prognosis of necrotizing ulcerative gingivitis

The disease does not involve periodontal ligament and alveolar bone. Appropriate local and systemic treatments are performed in the acute phase to regulate mood, increase body resistance, heal the lesions faster, leave no sequelae, and have a good prognosis.

If the disease is not properly treated or recurrent in the acute phase, and the necrotic tissue cannot be completely healed, it will turn into a chronic necrotic lesion with a poor prognosis. ^[4]