ACUTE GINGIVAL

INFECTIONS

DR KASHAF HAFEEZ
Learning Objectives:
 Classification of different acute gingival
lesions
 Different features of microbial lesions
 Different features of viral
gingivostomatitis
 Different clinical features and
complications of pericoronitis
 Management of these lesions
Classification:

 NUG (Necrotizing ulcerative gingivitis)

 Primary Herpetic Gingivostomatitis

 Pericoronitis
NECROTIZING ULCERATIVE
GINGIVOSTOMATITIS

Different terminologies used for NUG:

 Trench Mouth
 Vincent’s Stomatitis
 Vincent’s Infection
 Stomatitis Ulcerosa
NUG:
 It is a microbial disease of gingiva due to
an impaired host response.
 Acute infection.
 Death and sloughing of gingival tissues.
 Punched out crater like depressions of
interdental papillae.
 Grey pseudo memberanous slough
 Red, shiny and haemorrhagic
appaearnce
Advance case showing the destruction of
interdental paillae
heamorrhage
Most significant diagnostic criteria of NUG
are:

 Interdental necrosis and ulceration

 History of soreness and bleeding
Generalized involvement of papillae and
marginal gingiva with whitish necrotic
lesion.
Symptoms:
 Extremely sensitive
 Constant radiating pain
 Metallic foul taste
 Pasty saliva
 Local lymphadenopathy
 High fever
 Luekocytosis
 Loss of appetite
 General lasitude
Etiology:
 Role of bacteria
 Role of host response
 Local predisposing factors (trauma to gingiva,
smoking)
 Nutritional deficiency
 Debilitating disease (AIDS, Blood disorders)
 Psychosomatic factors (stress)
Management:

 Alleviation of the acute inflammation by

reducing the microbial load and removal
of necrotic tissue,

 Treatment of chronic disease either

underlying the acute involvement or
elsewhere in the oral cavity
Management:

 Alleviation of generalized symptoms

such as fever and malaise

 Correction of systemic conditions or

factors that contribute to the initiation or
progression of the gingival changes
FIRST VISIT:

 Medical history, habits and life style

 Examination
 Evaluation of oral hygiene

 Topical anesthetic – gently swab with moistened

cotton pellet to remove pseudomembrane and debris
 Remove superficial calculus

 Patients with moderate/severe NUG + systemic

involvement:
 Antibiotic regimen
Antibiotic regimen includes:

 Penicillin 500mg thrice daily for 7 days

 For penicillin allergic patients:
erythromycin or metranidazole 200 or
400 mg twice daily for 7 days
SECOND VISIT:

 Evaluation…………..improved?

 Gingival margins usually – erythematous

with no pseudomembrane

 Scaling if necessary
THIRD VISIT: (Maintenance Phase Treatment)

 Plaque control procedures

 Counselling on nutrition; smoking cessation,
other habits
 CHX continued (2 -3 weeks)
 Scaling and root planing (SRP)
 Re-evaluation after 1 month
PRIMARY HERPETIC
GINGIVOSTOMATITIS
Herpes simplex virus Type-I (HSV-1)
Affects infants and children less than 6 years

Primary infection is asymptomatic

Secondary manifestations - herpes labialis,

herpetic stomatitis, herpes genitalis, ocular
herpes, and herpetic encephalitis
Primary herpetic gingivostomatitis
 Herpetic lesions: (early stage)
 Herpetic lesion (late stage)
 Involvement of lip, gingiva and tongue
Oral signs:
 Diffuse, erythematous, shiny discoloration of the
gingiva

 Edema (gingival enlargement) and gingival bleeding

 Initial stage - discrete, spherical gray vesicles

 After 24 hours - vesicles rupture, painful, small

ulcers with a red, elevated, halo like margin,
depressed, yellowish or grayish white central
portion
0ral Symptoms:

 Generalized soreness of o.cavity

 Ruptured vessicles
 Extremely sensitive
Extra-Oral And Systemic Signs:

 Involvement of lips (herpes labialis ‘cold

sores’ ) and face with vesicles formation
 Cervical adenitis
 Pyrexia 101°F – 105°F
 Generalized malaise
Diagnosis:
 Patient history
 Clinical findings
 Confirmatory tests:
 Direct smear
 Inoculation of virus (tissue culture)
Differential Diagnosis:

 ANUG
 Erythema Multiforme
 Steven’s-Johnson Syndrome
 Lichen Planus
 Desquamative Gingivitis
 Apthous Stomatitis
Management:
If diagnosed within 3 days:
 Acyclovir - 15 mg/kg 5 times daily for 7
days

If diagnosed after 3 days of onset/

systemic manifestations
 -NSAID (ibuprofen)
 -Systemic antibiotics
PERICORONITIS
 Inflammation of the gingiva in relation to
the crown of an incompletely erupted
tooth

 It occurs most often in the mandibular

third molar area.

 Pericoronitis may be acute, subacute, or

chronic
Clinical features:
 The space between the crown of the tooth
and the overlying gingival flap (operculum)
is an ideal area for the accumulation of
food debris and bacterial growth

 Red, swollen, suppurating lesion

 Tender, with radiating pains to the ear, the

throat, and the floor of the mouth
Clinical features:

 Trismus

 Foul taste

 Swelling of cheek in the region of angle

of jaw
The patient may have systemic
complications such as:

 Fever
 Leukocytosis
 Malaise
Complications:
 Localized in the form of a peri-coronal abscess

 Posteriorly spread into the oro-pharyngeal area

 Medially to the base of the tongue (difficulty in

swallowing)

 Involvement of the sub-maxillary, posterior cervical,

deep cervical, and retropharyngeal lymph nodes
(severe case)

 Peri-tonsillar abscess formation, cellulitis, and Ludwig’s

angina are infrequent but potential sequelae of acute
pericoronitis
Treatment:
 Flush the area with warm water
 Swabbing with antiseptic
 Evaluate occlusion
 Excession of the operculum
 Tooth extraction
Patient comes to OPD with ulceration on
side of lips with burning sensation, on
examination there is erythema and
vesicles present on the junction of his lips

 What is the diagnosis and discuss the

management?
A 23 years old female patient comes to
dental OPD with fever and malaise, she
complaint about limited mouth opening
and pain. On examination there is swelling
and redness in her retromolar area.

 What is the diagnosis?

 How will you manage this patient?