Necrotizing Ulcerative

Gingivitis (NUG)
Group C Students:
Antonis Avraamides,
Konstantinos Papaeleftheriou,
Charalambos Eftychiou,
Marilyn Haddad,
Rianna Khakhria,
Maria Tsaoutou
Definition
Necrotizing ulcerative gingivitis (NUG) is a
distinctive form of periodontal diseases. It is
an infection of the gingival tissues caused by
gram a negative bacteria. It has an acute
clinical appearance and is distinguished by the
quick onset of:

Interdental
Gingival
Halitosis Bleeding gingival
discomfort
necrosis
 Etiological Factors
Psychologic stress factors is a main factor that can initiate
NUG.
Immunosuppression

Smoking

Local trauma

Weak nutritional status

Poor oral hygiene

Insomnia

Immunocompromised status associated with acquired

immunodeficiency syndrome (AIDS)
 The condition is still very prevalent in developing nations.

In Sub-Saharan Africa, where it primarily affects

underprivileged children from low socioeconomic
situations between the ages of 3 and 10 years.
Epidemiological
Data
India has also made similar observations, according to
reports.

According to hospital-based research conducted in

Nigeria over the past ten years, the frequency of NUG
among children is rising, reaching as high as 23% in
children under the age of 10.
 Volunteers from certain target populations, such as HIV
patients, military recruits, or those who are extremely
undernourished.

Epidemiological Diabetes is not considered as a potential risk factor,

however individuals with diabetes were favorably related
Data with the existence of NUG.

The link between adult-onset diabetes and periodontitis is

assumed to be related to neutrophil dysfunction,
microangiopathy, and delayed wound healing; therefore,
this study raises the possibility that the host response plays
a substantial role in the development of NUG.
Clinical Features
Highly inflamed, edematous, and hemorrhagic
interdental papillae

Damaged papillae will have a blunted, "punched

out" area that looks like a crater-like necrosis

Coated in a gray pseudomembrane.

Early diagnosis may occasionally be missed

because the interdental papilla tip is affected by
the ulceration in its early stages.
 Symptoms

Red and swollen Gums that bleed

Fever Gum pain
gums easily

Bad taste in the Large sores or

Gray buildup on Excessive
mouth or very loss of gum in
the gums salivation
bad breath between teeth
 Diagnosis

NUG is based on three essential

symptoms:

Sore gums,

Bleeding gums,

Ulceration and necrosis of the

interdental papillae (most
diagnostic characteristic)
 Differential Diagnosis

Viral infections (acute
NUG diagnosis can be
herpetic gingivostomatitis,
misinterpreted with:
infectious mononucleosis)
Some mucocutaneous
Bacterial infections conditions (desquamative
(gonococcal or gingivitis, multiform
streptococcal gingivitis) erythema, pemphigus
vulgaris)
Treatment
The aim of the treatment is to stop the disease spreading, tissue destruction, pain.
Whilst also eliminating discomfort.

Rinsing with chlorhexidine, or diluted hydrogen peroxide is essential for the

healing procedure.

Prescription of antibiotics such as:

Metronidazole of 500mg twice per day for a week Penicillin
 The most effective way against NUG is
full mouth debridement, which is
achieved by SRP. (Subgingival Removal
of Plaque.)

SRP is performed by Scaling and Root

Clinician’s
planning with the use of the ultrasonic
Intervention and hand instruments.

The patient should be firstly anesthesised

before the operation starts, either with
infiltration or block anesthesia.
Discussion

The three most

common signs are
papilla necrosis,
A specific type of acute
bleeding and
periodontal disease is
discomfort and the risk
NUG.
variables mentioned
above confirm the
diagnosis

To avoid sequelae and

craters in soft tissues
that will cause Finally, regular dental
subsequent relapses, hygiene compliance
treatment should be and maintenance do
planned out in steps, ensure better and more
with the acute phase reliable results.
receiving rapid
attention.
 • Necrotizing Ulcerative Gingivitis can be easily mistaken with other
diseases.

Conclusion • Therefore, the dentist must proceed with the diagnosis followed by an
adequate treatment of choice.

• However, the patients must also follow good OHI and visit the dentist
regularly for check ups in order to prevent the disease from getting
worse.
References
• ‘Acute Necrotizing Ulcerative Gingivitis (ANUG) - Mouth and Dental Disorders’.
• Melnick et al., ‘Epidemiology of Acute Necrotizing Ulcerative Gingivitis’.
• López et al., ‘Epidemiology of Necrotizing Ulcerative Gingival Lesions in
Adolescents’.
• Mizrahi, ‘NUG--necrotizing ulcerative gingivitis’.
• Folayan, ‘The Epidemiology, Etiology, and Pathophysiology of Acute Necrotizing
Ulcerative Gingivitis Associated with Malnutrition’.
• Cohen-Cole SA, Cogen RB, Stevens AW Jr., et. al. Psychiatric, psychosocial, and
endocrine correlates of acute necrotizing ulcerative gingivitis (trench mouth): a
preliminary report. Psychiatr Med. 1983 Jun