Necrotizing periodontal disease

Classification according to ICD-10
A69.1	Other spirochete diseases: necrotizing ulcerative gingivitis
ICD-10 online (WHO version 2019)

Mild form of necrotizing ulcerative gingivitis on the papillae of the lower front teeth

Among the necrotizing periodontal disease are necrotizing ulcerative gingivitis ( NUG ) and necrotizing ulcerative periodontitis ( NUP ) are summarized. In the acute state, they are called acute necrotizing ulcerative gingivitis ( ANUG ) or acute necrotizing ulcerative periodontitis ( ANUP ). The disease is also known as trench mouth ( English trench mouth ) known after common among soldiers in the trenches during the two world wars occurred. Both forms show a clinically similar appearance with interdental gingival necrosis and bleeding, severe pain, pronounced fetor ex ore ( bad breath ) and pseudomembranes . With NUP, there is also a loss of periodontal support tissue . In severe cases, lymphadenopathy , a general feeling of illness and fever can also occur.

Alternative names

In addition to the disease names mentioned, the disease is also named Vincent angina , Vincent stomatitis or Vincent infection after the French doctor Jean Hyacinthe Henri Vincent (1862–1950). It is also called acute membranous gingivitis , fusospirochaetal gingivitis or fusospirochaetosis .

etiology

Xenophon already observed 400 BC. These sores in the mouth of Greek soldiers. John Hunter (1728–1793) describes the clinical characteristics of the ANUG in 1778 and differentiates the disease from scurvy and chronic periodontitis . The manifestation of NUG / NUP usually results from an immunodeficiency that reduces the local defense against pathogens in the gingival area. It is often associated with mental and / or physical stress, excessive consumption of tobacco or a deficiency or malnutrition and poor oral hygiene connected. The exact etiology and pathogenesis are not clearly understood.

microbiology

Microbiologically , an anaerobic mixed flora with Treponema and Selenomonas strains as well as Prevotella intermedia , Porphyromonas gingivalis and fusiform bacteria such as Fusobacterium nucleatum , Fusobacterium periodonticum , Prevotella intermedia and Prevotella nigrescens as well as spirochetes are detected.

Differential diagnosis

In the differential diagnosis , the clinical picture of NUG / NUP must be differentiated from acute herpetic gingivitis, chronic desquamative gingivitis, or chronic periodontitis. Less frequently, it may also be aphthous stomatitis, bacterial gingivostomatitis, monoliasis , agranulocytosis, or an oral manifestation of dermatosis . In connection with an HIV infection or AIDS , atypical severe gingivitis and periodontitis are clinically evident , which are clinically very similar to NUG / NUP. The severe pain in the affected areas is a key differentiator from other periodontal diseases, which are usually painless.

therapy

Therapeutically, all hard and soft deposits are removed from the tooth surfaces with hand instruments and suitable ultrasound instruments under local anesthesia . A corticosteroid preparation is applied topically. In the case of pronounced necrotizing periodontal diseases, metronidazole is also prescribed, which is effective for the anaerobic gram-negative germ spectrum. Local rinsing of the oral cavity two to three times a day with 0.1 to 0.2% chlorhexidine digluconate solution helps . In the acute, very painful phase, analgesics are prescribed. In the event of damage to the tooth supporting structure, periodontal therapy is given after the acute symptoms have subsided .

Individual evidence

^ Herbert F. Wolf, Edith M. Rateitschak, Klaus H. Rateitschak: Parodontologie . Georg Thieme, 2004, ISBN 978-3-13-655603-0 , p. 85 ff . ( google.com ).
^ Definition of Vincent angina , medicinenet (English). Retrieved February 7, 2016.
↑ Parameter on acute periodontal diseases. American Academy of Periodontology. In: Journal of periodontology. Volume 71, Number 5 Suppl, May 2000, pp. 863-866, doi: 10.1902 / jop.2000.71.5-p.863 , PMID 10875694 .
↑ Simone Veihelmann, Necrotizing Periodontal Diseases , ZWP. Retrieved February 7, 2016.
↑ Frauke Berns, Carlo P. Marineklo, Nekrotisierende ulzerierende Parodontitis , Schweiz Monatsschr Zahnmed, Vol 114: 5/2004, pp. 479–489. Retrieved February 7, 2016.
↑ Necrotizing Periodontal Diseases , IWW, 12/2010 | S. 8. Lecture at the GABA symposium as part of the DGP-ARPA autumn conference, Bonn, September 17, 2010. Retrieved on February 7, 2016.

[1] Herbert F. Wolf, Edith M. Rateitschak, Klaus H. Rateitschak: Parodontologie . Georg Thieme, 2004, ISBN 978-3-13-655603-0 , p. 85 ff . ( google.com ).

[2] Definition of Vincent angina , medicinenet (English). Retrieved February 7, 2016.

[3] Parameter on acute periodontal diseases. American Academy of Periodontology. In: Journal of periodontology. Volume 71, Number 5 Suppl, May 2000, pp. 863-866, doi: 10.1902 / jop.2000.71.5-p.863 , PMID 10875694 .

[4] Simone Veihelmann, Necrotizing Periodontal Diseases , ZWP. Retrieved February 7, 2016.

[5] Frauke Berns, Carlo P. Marineklo, Nekrotisierende ulzerierende Parodontitis , Schweiz Monatsschr Zahnmed, Vol 114: 5/2004, pp. 479–489. Retrieved February 7, 2016.

[6] Necrotizing Periodontal Diseases , IWW, 12/2010 | S. 8. Lecture at the GABA symposium as part of the DGP-ARPA autumn conference, Bonn, September 17, 2010. Retrieved on February 7, 2016.