ANUG

• what are the classification of acute periodontal disorders?

  gingivitis or periodontitis
• what are the classifications of gingivitis?

  • traumatic
  • chemical
  • bacterial
  • viral
  • fungal
• classifications of periodontitis?

  • abcess
  • traumatic/parafunctional
  • bacterial
• acute inflammation is sudden in onset and short in durations. Will see: erythema, swelling, pain, warmth, loss of function
• NUG is a destructive disease of the periodontium caused by plaque bacteria and is confined to the gingival tissues

  AKA: Acute necrotising ulcerative gingivitis (ANUG), Trench mouth, Vincent’s Infection
• Prevalence of NUG?

  • 0.001% in british population
  • 17-25yrs
  • higher in those with HIV
  • high in malnourished children following viral/protozoal infection
• aetiology?

  • opportunistic infection of gingival tissue by commensal organisms
  • fusospirocheatal complex
  • spirochaetes invade tissue first
  • fusiform bacillus
  • mixed anaerobic infection
• Microbiology?

  • prevotella intermedia
  • fusobacteria
  • selmonas
  • treponema
• Why use USS?

  • water disrupts biofilm physically
  • oxygen bubbles burst releasing oxygen, killing anaerobes
• pathogenic mechanism of NUG?

  spirochaetes and fusiforms can invade tissue by

  • direct toxic effects
  • indirect activating and modifying host response

  develops in association with predisposing factors which lower body's defenses
• systemic predisposing factors of NUG?

  • smoking
  • stress
  • fatigue
  • diet
  • immunocompromisedd
• local predisposing factors of NUG?

  • smoking
  • pre-existing perio/gingivitis
  • poor oh
• clinical features of NUG?

  • painful bright red gingiva
  • bleeding
  • tenderness on probing
  • halitosis
  • ID papilla ulcerated
  • ulcer covered with yellow/grey slough
  • submandibular lymphadenopathy
  • high temp?
• what is slough?

  pseudomembranous
• first stage of NUG:

  • tip of id papilla in col
  • common lower ants
  • crater-like defects
• second stage of NUG:

  • gingivae bleed readily
  • halitosis
  • mod pain initially
• third stage of NUG:

  • necrotising lesions develops rapidly
  • pain more severe
  • yellow/white/grey slough
  • pronouce halitosis
• fourth stage of NUG:

  • ulceration may spread to adjacent tissues
  • pseudomembranous covering
  • lymphandentitis
  • raised temp
  • crater-like defect
  • punched out papilla
• initial stage of NUG

  
• moderate NUG

  
• more progressed NUG

  
• how would we treat the acute phase?

  • debridement: removing gross deposits of plaque and calculus using LA, USS flushes, removing sloughing material to reveal ulcerated bleeding tissue.
  • personal home care plan: intensive OHI, mouthwash and stop smoking
  • systemic antibiotics
  • review app 3-5 days later to review OHI and continue scaling
• what type of MW recommended?

  • peroxyl - oxidising mw 3% hydrogen peroxide
  • chx mw 0.2% x 10ml bd for 1 min
• what antibiotics might be prescribed?

  • metronidazole 200mg - 400mg tds 3 days (pregnancy/warfarin?)
  • penicillin V 250mg qds 5 days
• long term tx?

  • improve OH
  • scaling
  • smoking cessation
  • diet advice
  • stress management
  • surgical correction/recontouring
  • counselling for recreational drugs
• Why might recurrence occur?

  after acute phase subsides, inadequate tx and predispoding factors persists
• 1. NUG
  2. necrotising ulcerative periodontitis
  3. necrosis of periodontal ligaments and bone
• NUP

  
• NUS - necrotising ulcerative stomatitis