Necrotizing+Perio+Disease

Ashley and Candice **NUG- Necrotizing Ulcerative Gingivitis** is a microbial disease of the gingiva in the context of an impaired host response. It is usually classified as an acute disease and is characterized by the death and sloughing of gingival tissue. NUG can cause tissue destruction involving the periodontal attchment apparatus, especially in patients with long standing disease or sever immunosuppression. Clinically: The interdental papilla is punched out and necrotic it has ulcerations is is coverd by a grey pseudomembrane slough. Also the ulcerated margin is surrounded by a erythmatous halo. These lasions are painfil and bleed easly and foul odor will present. Microorganisims involved : high levels of P. intermedia, especially spirochetes, fusiform bacilli, cocci, rods, Treponema and Selenomonas species. Microscopically the description of NUG lesions can be identified in four zones: Radiograhically:  none NUG does not affect the periodontium. Differential Diag:  herpetic gingivostomatitis, chronic periodontitis, desquamative ginigvitis, apthous ulcers, erosive lichen planus.
 * 1) The Bacterial Zone- large masses of bacteria containing morphotypes including spirochetes
 * 2) The Neutrophil Rich Zone- abundant leukocytes and neutrophils with many spirochetes
 * 3) The Necrotic Zone-dead cells, spirochetes and other bacteria
 * 4) <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Spirochetal Infiltration zone- intact tissue elements infiltrated by spirochetes but no other bacteria

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">**NUP: Necrotizing Ulcerative Periodontitis** may be an extension of NUG into the periodontal structures leading to periodontal attachment and bone loss. <span style="background-color: #00ffff; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Clinically <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">: necrosis and ulceration of the coronal portion of the interdental pappillae and gingival margin, with a painful, erythmatous border of free gingiva. deep interdental osseous craters. Patients may present with oral malodor, fever, malaise, or lymphadenopathy. patient will bleed easily have low probing depths due to the tissues necrosis. <span style="background-color: #00ffff; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Microorganisms invoved: <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">High levels of yeasts and herpeslike viruses were also found may be due to oppurtunistics microbes in an immunocompromised host. <span style="background-color: #00ffff; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Radiographically: <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> Lamina dura presents as fuzziness at interdental papillae. <span style="background-color: #00ffff; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Differential Diagnosis <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">: Acute periodontitis, Agranulocytosis, acute leukemias, Benign mucosal pemphigoid, Herpetic gingivostomatitis.
 * 1) <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Bacterial zone- surface biofilm composed of mixed microbial flora w/ different morphotypes and a subsurface w/ aggregations of spirochetes.
 * 2) <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Neutrophil rich zone- abundant number of PMNs.
 * 3) <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Necrotic zone- necrotic cells.
 * 4) <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Spirochetal infiltration zone- was not able to identify becuase of the biopsy technique used.