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Necrotizing Periodontal Disease

Written by Ada’s Medical Knowledge Team

Updated on

What is Necrotizing Periodontal Disease?

Necrotizing Periodontal Disease is a disease of the gum and other tissues surrounding the teeth. It usually affects children or teenagers. This condition is due to bacteria or other microorganisms, which cause inflammation inside the mouth. This inflammation leads to progressive destruction of the gums and other tissues around the teeth. Necrotizing Periodontal Disease can progress through different stages. The mildest one involves only disease of the gums. It can progress and involves other structures of the mouth, like tongue and palate, cheek and teeth (condition is called necrotizing stomatitis). It mostly affects people with a weakened immune system, and is more common in developing countries.

Other names for Necrotizing Periodontal Disease:

  • Acute necrotizing ulcerative gingivitis
  • Trench mouth
  • Vincent gingivitis
  • Vincent infection
  • Vincent stomatitis
  • Vincent angina

Signs and symptoms of Necrotizing Periodontal Disease

Usually initial symptoms are spontaneous gum bleeding and gum pain. By examination of the mouth, erosion of the gums and formation of pseudomembrane may be seen. Other possible symptoms include bad smelling breath and enlarged or painful lymph glands, which may appear as nodules under the lower jaw.

If the condition progresses to more severe stages, there can be widespread damage to other structures of the mouth, with more extended gum erosion, loosening or loss of the teeth or erosion of the cheeks. Part of the bone under the teeth may be lost too.

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Causes and risk factors of Necrotizing Periodontal Disease

Necrotizing periodontal disease is caused by microorganisms. These include certain bacteria, viruses or yeasts. When the immune response of the person is not working properly, these microorganisms can proliferate and create damage to the tissues around the teeth.

Most people affected by this condition have a weakened immune system, for example HIV-positive people.

Other risk factors for developing this condition include:

  • Malnutrition and non-safe drinking water or food
  • poor oral hygiene
  • tobacco smoking
  • psychological stress

Diagnosis of Necrotizing Periodontal Disease

Necrotizing Periodontal Disease can be diagnosed through a doctor’s examination. Useful for the diagnosis is the patient’s medical history; risk factors need to be investigated. An x-ray may be used to check the eventual loss of the bone under the teeth. Blood tests are also needed to check for associated conditions such as HIV, and other blood conditions.

Necrotizing Periodontal Disease Treatment

Treatment depends on the stages of the condition. The earlier it is started the more effective it will be.

Treatment procedures include:

  • mechanical debridement of the lesions.
  • use of antiseptic mouth rinses or antibiotics
  • painkillers such as paracetamol
  • oral hygiene measures
  • correct other risk factors (avoiding tobacco smoking, psychological stress, and malnutrition)
  • for advanced stages a surgery may be needed to correct defects in soft tissues or bones

Oral hygiene plays a key role in treatment and prevention of this condition. It’s recommended to brush teeth twice a day and regularly check teeth health by a dentist.

A dentist consultation might be needed as well. The condition can be complicated with tooth loss.

Affected people may have a serious underlying condition, such as HIV. These conditions need to be investigated and treated too.

Prevention

To prevent necrotizing periodontal disease, risk factors need to be managed. This includes oral hygiene measures and adequate nutrition, with safe drinking water and food. Avoiding tobacco smoking and reducing stress can help too. Underlying conditions, including HIV, should be treated.

Necrotizing periodontal disease and noma disease

Necrotizing periodontal disease in some cases progresses and seriously damages the tissue of the mouth and face. This complication is called cancrum oris or noma disease. It may present with swollen or disfigured face, cheek pain or discoloration, mouth and cheek erosion with exposure of the bones. Other possible symptoms are inability to open the mouth with anorexia, loss of teeth and speech problems. It mostly occurs in malnourished children, especially in tropical countries. This is a serious and debilitating condition and if left untreated can have a very poor prognosis. Early treatment with oral hygiene measures and antibiotics may prevent the tissue damage or reduce its extent. Treatment for later stages includes a surgery, which is often complex. Preventing noma disease implies: food security (safe drinking water and food), measles vaccination, prevention of malaria and HIV, early detection and treatment of necrotizing gingivitis and stomatitis. oral hygiene measures

Necrotizing periodontal disease FAQs

Q: Is Necrotizing Periodontal Disease contagious? A: No. The microorganisms that cause the condition are very common, however only in people with weakened immune systems or other risk factors they proliferate and cause the condition. In otherwise healthy people they can easily control these infections and don’t develop the condition.

Q: Is Necrotizing Periodontal Disease reversible? A: if discovered in the early stages of the condition can be successfully treated. In later stages the damages might be extended and not reversible. However even in these stages a treatment is essential to control the condition and prevent further extension.

Q: What causes necrotizing periodontal disease? A: Necrotising periodontal disease is caused by some microorganisms. These include certain bacteria, viruses and yeasts. These microorganisms are common and frequently they can be found in the mouth of healthy people. When the immune system is competent and working properly it is able to control these microorganisms so that they don’t cause the disease. People with weakened or suppressed immune system, instead, are not able to control the infection, so that the disease can occur.

Q: How is necrotizing periodontitis treated? A: Treatment of necrotizing periodontitis involves use of antiseptic mouth rinses or antibiotics and other oral hygiene measures. It is advised to brush teeth twice a day and regularly visit a dentist for oral health check-ups. In severe cases a surgery might be needed.

Q: What is noma disease? A: noma disease is a serious infection of the mouth and face. It can be a sequel of necrotizing periodontal disease. Most commonly affects malnourished children in less developed countries. The infection causes rapid damages to mouth and face tissues and can lead to severe face disfiguration.

Sources: https://www.ncbi.nlm.nih.gov/books/NBK557417/ https://dermnetnz.org/topics/necrotising-periodontal-disease

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