Acute Periodontal Disorders

Question 1

What is NUG?

Answer 1

Acute inflammatory, destructive disease of the periodontium caused by plaque bacteria confined to the gingival tissues.

Question 2

What are historical names for NUG?

Answer 2

• Trench Mouth

- Vincent’s infection

Question 3

Describe the prevalence of NUG

Answer 3

-Durring WWW II frequently seen in military personnel after WW declined
-Substantially less common in developed western societies (0.001% in British / Danish population)
-More common in developing countries such as Nigeria
High incidence in HIV positive pts in developed countries
-Prevalent in 17-25 year olds

Question 4

Describe the aetiology of NUG

Answer 4

Opportunistic infection of gingival tissues by commensal bacteria

• asscoaited with fusospirocheatal complex orgnaisms
• E.g. Fusobacteria, Treponema, Selenomonas, provotella intermedia
• These spirochaetes and fusiform invade gingival tissues and cause tissue destruction directly and indirectly.
• Disease develops in association with predisposing factors that have lowered body defences

Question 5

List the predisposing factors of NUG

Answer 5

SYSTEMIC RISK FACTORS

• smoking
• stress & fatigue
• malnutrition - associated with poor protein intake in developing countries
• Downs syndrome
• Systemic conditions - leukaemia
• Lowered immunity - steroid users

LOCAL RISK FACTORS

• Pre-exisiting gingivitis + periodontitis
• Poor OH
• Smoking

Question 6

List clinical features of NUG

Answer 6

• Ulceration + necrosis of ID papillae
• Punched out appearance
• Pseduomembranous covering - grey sloth (fibrin and necrotic tissue, leukocytes, mass of bacteria, erythrocytes)
• Unpleasant odour
• Metallic/ unpleasant taste
• Lesions start at top of papilla to col - crater like defect
• Mostly seen on anterior teeth of mandible or any
• Sequestrum (fragments of dead bone if extends to facial bone)
• Readily bleeding (acute inflammation and necrosis of underlying connective tissue)
• Lymphadentitis
• Raised temperature

Question 7

Describe the acute phase of treatment

Answer 7

1. Commence ASAP after diagnosis
2. Hydrogen peroxide (colgate peroxyl) as MW applied - mechanical cleansing and release oxygen)
3. CHX MW 0.2% is pt cannot brush
4. Personal OHI
5. Reduce/ stop smoking
6. Systemic microbials

Question 8

What systemic antimicrobials should be given to an NUG patient?

Answer 8

1. Metronidazole 200mg 3x daily for 3 days
2. For severe cases/ malaise/ fever 400mg 3x daily for 3 days

Metronidazole should not given to pregnant or Warfarin patients

3. Penicillin V 250mg 4x daily for 5 days

Question 9

What and what happens in a review appointment?

Answer 9

3-5 days after initial appointment

• Review OH - introduce deeper cleaning
• Complete debridement
• Maintenance should be arranged