gingivitis, necrotizing

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An ulcerative condition of the gingiva characterized by gingival bleeding, pain, and loss of the apices of the interdental papillae, producing a punched out appearance. It is also known as Vincent's gingivitis, Vincent's angina, Plaut–Vincent angina [H. K. Plaut (1858–1928), German physician; J. H. Vincent (1862–1950), French physician], or trench mouth. In severe conditions the ulceration may spread to the throat and tonsils with associated fever and malaise. A grey slough (pseudomembrane) is frequently seen on the gingival margins, together with tissue necrosis causing a characteristically unpleasant halitosis. There is a cellular infiltrate of polymorphonuclear leucocytes, plasma cells, and lymphocytes. The aetiology is usually poor oral hygiene, often associated with stress or smoking. Bacteria implicated in the condition are Treponema vincentii, Fusobacterium nucleatum, and Prevotella intermedia. Treatment is by correcting oral hygiene deficiencies, oxygenating mouthwashes, and systemic antibiotic therapy. If the treatment is inadequate, the acute condition may become chronic, developing into a chronic necrotizing periodontitis. Necrotizing gingivitis is associated with cancrum oris.

Further Reading:

Minsk L. Diagnosis and treatment of acute periodontal conditions. Compend Contin Educ Dent 2006;27:8–11.MacCarthy D., Claffey N. Acute necrotising ulcerative periodontitis is associated with attachment loss. J Clin Period 1991;18:776–9.

Subjects: Dentistry.

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