Necrotizing periodontal diseases

Last updated
Necrotizing periodontal diseases
Other namesNPD
Ulcerative necrotizing gingivitis.jpg
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, malaise
Complications Progression
Types Necrotizing gingivitis, Necrotizing periodontitis, Necrotizing stomatitis
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, Caucasian ethinicity, 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, clinical attachment loss and alveolar bone loss (in NP, NS)
Prevention oral hygiene
Treatment debridement (dental), metronidazole

Necrotizing periodontal diseases is one of the three categories of periodontitis as defined by the American Academy of Periodontology/European Federation of Periodontology 2017 World Workshop classification system. [1] [2]

Contents

Necrotizing periodontal diseases are a type of inflammatory periodontal (gum) disease caused by bacteria (notably fusobacteria and spirochaete species). The diseases appear to represent different severities or stages of the same disease process, although this is not completely certain. These diseases are usually have a sudden onset with sudden onset. The mildest on the spectrum is necrotizing gingivitis (NG), followed by the successively more severe conditions necrotizing periodontitis (NP), necrotizing stomatitis and finally cancrum oris (noma), which is frequently fatal.

Necrotizing gingivitis

Necrotizing gingivitis: painful, bleeding, sloughing ulceration and loss of the interdental papillae (usually of the lower front teeth) Ulcerative necrotizing gingivitis.jpg
Necrotizing gingivitis: painful, bleeding, sloughing ulceration and loss of the interdental papillae (usually of the lower front teeth)

Necrotizing gingivitis, is a common, non-contagious infection of the gums. If improperly treated necrotizing may become chronic and/or recurrent. In developed countries, necrotizing gingivitis occurs mostly in young adults with predisposing factors such as psychological stress, sleep deprivation, poor oral hygiene, smoking, immunosuppression and/or malnutrition. In developing countries, necrotizing gingivitis occurs mostly in malnourished children. Due to shared predisposing factors in a population (e.g. students during a period of examinations, armed forces recruits) necrotizing gingivitis is known to occur in epidemic-type patterns. This has led to the popular belief that necrotizing gingivitis is contagious, but this is not the case. The main features of necrotizing gingivitis are painful, bleeding gums and ulceration and necrosis of the interdental papilla. There may also be intra-oral halitosis, cervical lymphadenitis (swollen lymph nodes in the neck) and malaise. Treatment of the acute disease is by debridement and antibiotics, usually metronidazole. Poor oral hygiene and other predisposing factors may need to be corrected to prevent recurrence. Necrotizing gingivitis is also known as trench mouth, as it was observed to occur in the mouths of front line soldiers during World War I.

Necrotizing periodontitis

Necrotizing periodontitis (NP) is where the infection leads to attachment loss (destruction of the ligaments anchoring teeth in their sockets), but involves only the gingiva, periodontal ligament and alveolar ligament. If attachment loss is present in the disease, it is termed NP, unless the disease has progressed beyond the mucogingival junction. NP may be an extension of NG into the periodontal ligaments, although this is not completely proven. In the meantime, NG, NP, and NS are classified together under the term necrotizing periodontal diseases. [1]

Necrotizing stomatitis

Progression of NP into tissue beyond the mucogingival junction characterizes necrotizing stomatitis. Atypical case reports describe NS development without prior NPD lesions. [1]

Noma

Noma in an adult male. Note destruction of orofacial tissues. Noma.png
Noma in an adult male. Note destruction of orofacial tissues.

Noma (also termed cancrum oris) is a necrotizing and destructive infection of the mouth and face, and therefore not strictly speaking a periodontal disease. In modern times, this condition usually occurs in malnourished children in developing countries. It may be disfiguring and is frequently fatal. It has been suggested that all cases of noma develop from pre-existing NG, but this is not confirmed. Furthermore, the vast majority of cases of NG and NP will not progress to the more severe forms, even without treatment.

Vincent's angina

Strictly speaking, Vincent's angina is not a necrotizing periodontal disease. However, Vincent's angina is widely confused with necrotizing gingivitis (previously also called "Vincent's gingivitis"). Vincent's angina is tonsillitis and pharyngitis, [3] and does not typically involve the gums. Many publications using the term "Vincent's angina" date from the twentieth century, and the term is not so common in modern times. The condition is named after Jean Hyacinthe Vincent, a French physician who was working at the Paris Pasteur Institute. Vincent described a fusospirochetal infection of the pharynx and palatine tonsils, causing "ulcero-membranous pharyngitis and tonsillitis", [4] which later became known as Vincent's angina. Later in 1904, Vincent described the same pathogenic organisms in "ulceronecrotic gingivitis".

Nomenclature

The necrotizing periodontal diseases used to include the words "acute" and "ulcerative" in their names (e.g., "necrotizing ulcerative gingivitis"). Neither term is included in the AAP/EFP 2017 World Workshop classification on Necrotizing Periodontal Diseases.

Related Research Articles

<span class="mw-page-title-main">Periodontal disease</span> Medical condition

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

<span class="mw-page-title-main">Necrotizing gingivitis</span> Non-contagious, painful bacterial infection of the gums

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. 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).

<span class="mw-page-title-main">Toothache</span> Medical condition of the teeth

Toothache, also known as dental pain or tooth pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

<span class="mw-page-title-main">Stomatitis</span> Medical condition

Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline (supragingival), or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

Vincent's angina, is pharyngitis and tonsillitis, caused by infection with two types of bacteria called fusiform and spirochaetes. This symbiosis of bacteria is sometimes termed a "fusospirochaetal" infection.

<span class="mw-page-title-main">Noma (disease)</span> Medical condition

Noma is a rapidly progressive and often fatal infection of the mouth and face. This disease is strongly linked to poverty and malnutrition, and predominantly affects children between the ages of two and six years in the least developed countries around the world, primarily in sub-Saharan Africa. Noma has also been seen in severely immunocompromised people in the developed world. In 2023 noma was added to the World Health Organization's list of neglected tropical diseases.

<span class="mw-page-title-main">Veterinary dentistry</span> Branch of veterinary medicine

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

Desquamative gingivitis is an erythematous (red), desquamatous (shedding) and ulcerated appearance of the gums. It is a descriptive term and can be caused by several different disorders.

Bleeding on probing (BoP) which is also known as bleeding gums or gingival bleeding is a term used by dentists and dental hygienists when referring to bleeding that is induced by gentle manipulation of the tissue at the depth of the gingival sulcus, or interface between the gingiva and a tooth. BoP is a sign of periodontal inflammation and indicates some sort of destruction and erosion to the lining of the sulcus or the ulceration of sulcular epithelium. The blood comes from lamina propria after the ulceration of the lining. BoP seems to be correlated with Periodontal Inflamed Surface Area (PISA).

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

<span class="mw-page-title-main">Jean Hyacinthe Vincent</span> French physician

Jean Hyacinthe Henri Vincent was a French physician who was a native of Bordeaux. He was an associate professor at Val-de-Grâce, as well as medical inspector general with the French Army. Later he attained the chair of epidemiology at Collège de France.

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

<span class="mw-page-title-main">Gingivitis</span> Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums; ulitis is an alternative term. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that are attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

Gingival disease is a term used to group the diseases that affect the gingiva(gums). The most common gingival disease is gingivitis, the earliest stage of gingival-related diseases. Gingival disease encompasses all the conditions that surround the gums, this includes plaque-induced gingivitis, non-dental biofilm plaque-induced gingivitis, and periodontal diseases.

Prevotella intermedia is a gram-negative, obligate anaerobic pathogenic bacterium involved in periodontal infections, including gingivitis and periodontitis, and often found in acute necrotizing ulcerative gingivitis. It is commonly isolated from dental abscesses, where obligate anaerobes predominate. P. intermedia is thought to be more prevalent in patients with noma.

Chronic periodontitis is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Periodontitis initially begins as gingivitis and can progress onto chronic and subsequent aggressive periodontitis according to the 1999 classification.

In dentistry, numerous types of classification schemes have been developed to describe the teeth and gum tissue in a way that categorizes various defects. All of these classification schemes combine to provide the periodontal diagnosis of the aforementioned tissues in their various states of health and disease.

References

  1. 1 2 3 Herrera, D., Retamal-Valdes, B., Alonso, B., Feres, M. (June 2018). "Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions: Dd56II Joint EFP-AAP Workshop". Journal of Periodontology. 89: S85–S102. doi: 10.1002/JPER.16-0642 . ISSN   0022-3492 . Retrieved 10 July 2023.
  2. Caton, J. G., Armitage, G., Berglundh, T., Chapple, I. L. C., Jepsen, S., Kornman, K. S., Mealey, B. L., Papapanou, P. N., Sanz, M., Tonetti, M. S. (June 2018). "A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification". Journal of Periodontology. 89: S1–S8. doi: 10.1002/JPER.18-0157 . hdl: 2027.42/144587 . ISSN   0022-3492 . Retrieved 10 July 2023.
  3. DeGowin, EL (1981). Bedside diagnostic examination (4th ed.). New York: Macmillan. ISBN   9780023280306.
  4. Taylor, FE; McKinstry, WH (1917). "The Relation of Peri-dental Gingivitis to Vincent's Angina". Proceedings of the Royal Society of Medicine. 10 (Laryngol Sect): 43–8. PMC   2017821 . PMID   19979715.