Necrotizing gingivitis

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

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 interdental 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).^[1]

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.