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Acute Necrotising Ulcerative Gingivitis

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1,602 Words ACUTE NECROTIZING ULCERATIVE GINGIVITIS (Fusospirochetosis; Trench Mouth; Vincent's Infection or Angina) Acute Necrotising Ulcerative Gingivitis (ANUG) is an acute or recurrent gingivitis of young and middle-aged adults characterised clinically by gingival erythema and pain, fetid odour, necrosis and sloughing of interdental papillae and marginal gingiva which gives rise to a grey pseudomembrane; fever, regional lymphadenopathy, and other systemic manifestations may also be present. According to Keys and Bartold (2000) ANUG primarily affects young adults of 18 to 30 years and is now relatively uncommon. This disease has been described as far back as the days of Hippocrates and is known by many synonyms. Shiloah (2008) describes ANUG as having a complex aetiology. Various micro-organisms are often present in the areas of the gingival tissues in large numbers and are felt to play a significant but poorly defined role in the pathogenesis. Furthermore, numerous studies have hypothesized on the significance of secondary predisposing aetiological factors, including poor oral hygiene, stress, smoking, alcohol consumption, impaired chemotaxis, general debilitation and malnutrition. Folayan (2004) argues that with the advent of antibiotics and with improved nutritional status, the incidence had been virtually eliminated in developed countries. ...read more.


Furthermore, if still left untreated NUP can progress to necrotizing stomatitis, which can be potentially life threatening. Necrotizing stomatitis is an extremely destructive infection that stretches beyond the mucogingival junction into the contiguous palato-pharyngeal or mucous tissues. The stages of periodontal disease are shown in the below diagram. If the disease is allowed to progress, teeth will be lost, which may require the patient being treated by a prosthodentist for the fitting of dentures or the insertion of implants. The remainder of the treatment plan would be carried out by a General Dental Practioner, although referral to a specialist Periodontist may be needed if complications or re-infection occur. Shiloah(2008), Folayan (2004), Keys & Bartold (2000) and Alpagot (2003) all identify the principles of treatment to be the removal of calculus and plaque from the area using ultrasonic descaling. Where the use of local anaesthesia will be required due to the pain that the patient will already be experiencing considerable pain. The use of antibiotics (Metronidazole) is also identified to reduce the actual infection and any possibility of its spreading to the cheeks, gums and the jaw bone. The use of chlorhexidine mouth washes to improve dental hygiene is also seen as a sensible adjunctive therapy. ...read more.


Lymphadenopathy A swelling of the lymph nodes. Motile Actively moving, self-propelled. Mucogingival junction The mucogingival junction (MGJ) is the junction between the soft, fleshy mucus membrane of the oral cavity and the tough, collagen rich gingiva. The MGJ remains stationary throughout life although the gingiva around it may change in height, due to hyperplasia, recession or attachment loss. Mucous membrane The lubricated inner lining of the mouth, nasal passages, vagina and urethra; any membrane or lining which contains mucous secreting glands. Necrosis The various changes indicative of cell death and caused by the progressive degradative action of enzymes, it may affect groups of cells or part of a structure or an organ. Palatopharyngeal One of a pair of ridges or folds of mucous membrane which passes downward from the posterior margin of the soft palate to the lateral wall of the pharynx. It encloses the palatopharyngeus muscle and forms the posterior margin of the tonsillar fossa. It also demarcates the isthmus of fauces from oropharynx. Treponema Genus of bacteria of the spirochaete family (Spirochaetaceae). Papilla The gingival structures occupying the space between adjoining teeth. Pathology The branch of medicine concerned with disease, especially its structure and its functional effects on the body. Pseudomembrane A thick, tough fibrinous false membrane on the surface of a mucous membrane or the skin. ...read more.

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