Acute necrotizing ulcerative gingivitis

Abstract

Introduction. Acute necrotizing ulcerative gingivitis (ANUG) is a relatively rare and yet specific infectious disease of the gingival tissue characterized by gingival necrosis and ulceration, gingival pain, and bleeding, affecting <1% of the population. Although the prevalence of this disease is not high, its clinical importance is clear, as it represents the most serious of the diseases associated with dental biofilm, which, if left untreated, can lead to severe complications such as necrotizing ulcerative periodontitis or noma, which is usually fatal. Case statement. This report presents a clinical case of ANUG and its clinical management. Discussions. An 18-year-old male patient presented to the Department of Dentistry with complaints of gingival pain and bleeding, a fetid odor from the oral cavity, and nutritional deficiencies. History of the disease: oral hygiene has definitely been ignored; he smokes up to 20 cigarettes a day. The intraoral examination revealed the clinical picture characteristic of ANUG: swelling and edema of the gums, which bleed easily when touched; multiple ulcerative erosions covered with fibrin deposits; and an unpleasant odor from the oral cavity. Silness Loe plaque index = 3. Submandibular lymph nodes are enlarged and painful to palpation. Microbiological investigations demonstrated the excessive presence of Fusobacteria and Porphyromonas species. Emergency treatment was administered in the dental office, and home treatment was prescribed. Recommendations were directed towards a complete general examination, strict adherence to personal oral hygiene, and smoking cessation. Conclusion. Although it is quite rare in medical practice (˂1%), the complications of ANUG are quite severe, from necrotizing ulcerative periodontitis to noma. By presenting this clinical case, we draw the attention of the dental community to the risks to which patients are exposed in the case of ignoring personal oral hygiene and the importance of common risk factors, such as smoking, in the occurrence of ANUG. infectious disease of the gingival tissue characterized by gingival necrosis and ulceration, gingival pain, and bleeding, affecting <1% of the population. Although t he prevalence of this disease is not high, its clinical importance is clear, as it represent s the most serious of the diseases associated with dental biofilm, which, if left untreated, can lead to s evere complications such as necrotizing ulcerative periodontitis or noma, which is usually fatal. Case statement. This report presents a clinical case of ANUG and its cl inical management. Discussions. An 18-year-old male patient presented to the Department of Dentistry with complaints of gingival pain and bleeding, a fetid odor fr om the oral cavity, and nutritional deficiencies. History of the disease: oral hygiene has definit ely been ignored; he smokes up to 20 cigarettes a day. The intraoral examination revealed the c linical picture characteristic of ANUG: swelling and edema of the gums, which bleed easily when touched; mu ltiple ulcerative erosions covered with fibrin deposits; and an unpleasant odor from the oral cavity. Silness Loe plaque index = 3. Submandibular lymph nodes are enlarged and painful to palpat ion. Microbiological investigations demonstrated the excessive presence of Fusoba cteria and Porphyromonas species. Emergency treatment was administered in the dental office, and home treatment was prescribed. Recommendations were directed towards a complete general e xamination, strict adherence to personal oral hygiene, and smoking cessation. Conclusion. Although it is quite rare in medical practice (˂1%), th e complications of ANUG are quite severe, from necrotizing ulcerative periodontitis to noma. By presenting this clinical case, we draw the attention of the dental community to the risks to which patients are exposed in the case of ignoring personal oral hygiene and the importance of common risk factors, such as smoking, in the occurrence of ANUG.