Chapter 9

Question 1

what is necrotizing periodontal disease

Answer 1

• includes necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative periodontitis (NUP)
• NUG and NUP are included as separate diseases although they may be part of modifiers of systemic diseases such as an HIV infection

Question 2

can NUG be acute

Answer 2

• no, acute was eliminated from the NUG because the AAP concluded that ‘acute’ was a clinical descriptive term and should not be used as a diagnostic classification term

Question 3

other names for NUG

Answer 3

• trench mouth

- common in WWI soldiers

Question 4

what is the age range most often affected by NUG

Answer 4

• 18-30

Question 5

what is the etiology behind NUG

Answer 5

• bacteria: prevotella intermedia, spirochetes. spirochetes invade deep into connective tissue
• other etiologic factors include stress, immune suppression (chronic steroid use), smoking, malnutrition, pre-existing gingivitis and tissue trauma (eg toothpick use)

Question 6

what will immunosuppression cause

Answer 6

• decreased PMN function

Question 7

what are some clinical features of NUG

Answer 7

• papillary necrosis: tip of interdental gingiva is described as “punched out”
• gingival bleeding, often spontaneous (occurs just by touching the gingiva)
• severe, intense pain
• no bone loss or attachment loss - only gingival findings

Question 8

what is differential diagnosis

Answer 8

• a process where a doctor differentiates between two or more conditions that could be behind a person’s symptoms

Question 9

what is the differential diagnosis process for NUG

Answer 9

• rule out other gingival diseases including herpetic infections
• NUG must have the 3 criteria described: punched out papilla, severe pain, spontaneous bleeding

Question 10

what are signs and symptoms that might not always be found in NUG

Answer 10

• lymphadenopathy (lymph nodes)
• fever
• fetid oral odor (variable findings)

Question 11

what is the treatment for NUG

Answer 11

• often a patient comes to the office because of intense pain
• once a diagnosis is made, treatment is done
• analgesics, if needed, periodontal debridement and oral hygiene instruction
• use of antibiotics such as metronidazole is controversial
• if not resolved, send for medical consultation. nutrition counselling, oral hygiene instruction and smoking cessation may also be necessary

Question 12

what is necrotizing ulcerative periodontal disease

Answer 12

• infection characterized by:
• gingival necrosis
• rapid and extensive clinical attachment loss and bone loss
• gingival recession
• severe where bone is denuded (exposed)

Question 13

who do we most often see NUP in

Answer 13

• most commonly seen in immunosuppressed patients (ex: HIV infections)

Question 14

main difference between NUG and NUP

Answer 14

• NUG involves the gingival unit, usually immunosuppressed (HIV) ​
• NUP involves the attachment apparatus, extensive CAL & bleeding (HIV/ AIDS)

Question 15

what are the 3 criteria for NUG

Answer 15

• PAIN
• spontaneous bleeding
• punched out papilla/interdental necrosis