1. Acute Gingival Abscess

2. Acute Herpetic gingivostomotitis

3. Pericoronitis

4. Streptococcal Gingivostomotitis

5. Acute Narcotizing Ulcerative Gingivitis

6. Acute Candidasis

7. Aphthous Stomatitis

( Necrotizing periodontal diseases)

Gingival Abscess

Localized painful rapidly expanding lesion

of sudden onset.

Etiology

Due to impaction of foreign object such

as tooth brush bristle or fibrous food.

Clinical Features

Short duration

Limited to marginal gingiva and interdental papilla.

Appears as red swelling with smooth surface.

Lesion become fluctuant within24 to 48 hr.

Adjacent teeth often sensitive to percussion.

Management

Acute Herpetic Gingivostomatitis

( A.H.G.S. )

Infection of oral cavity caused by:

HERPES SIMPLEX VIRUS

Occurs most frequently in infants and children

younger than 6years of age.

Clinical Features

The condition appears as diffuse erythematous,

shiny involvement of gingiva.

In its initial stage characterized by presence

of discrete spherical Grey vesicles which

occurs on the gingiva, labial and buccal

mucosa, soft palate, pharynx,

sublingual mucosa,& the togue.

Oral Symptoms

Generalized soreness of the oral cavity

Extraoral Systemic Signs and Symptoms

- Herpetic involvement of lips and face

-Cervical Lymphadenitis and Fever

are common

A.H.G.S. is contagious

Histpathology

The fully developed vesicles:

Is cavity in the epithelial cells with occasional PMNs.

Inclusion body are found in nuclei of epithelial

cells bordering vesicles

Deferential Diagnosis & Diagnosis

- ANUG.

- Erythema Multiforme.

- Bullous lichen planus

- Desquamative gingivitis

- Aphthous stomatitis

Management

1. Palliative measurement.

2. Remove local deposits.

3.Topical anesthetitic M. Wash.(Dyclonine hydrochloride

4. Lidocaine viscouse- 2% or 5% aqueous diphenhydramine.

5. Mouth wash &antibiotics.

PERICORONITIS

It’s the inflammation of the gingiva in relation

to the crown of an incompletely erupted tooth.

It occurs most frequently in mandibular third molar.

Clinical Features

Acute pericoronitis is identified by varying

degrees of involvement of the pericoronal

flap and adjacent structure.

Complications

Pericoronal Abscess

May spread posteriorly into the oropharyngeal area

and medially to the base of the tongue.

Peritonsillar Abscess

Cellulitis

Ludwigs Angina

Treatment

STREPTOCOCCAL GINGIVOSTOMATITIS

Rare condition, More commonly, secondy infection

Of the gingiva with Haemolytic streptococci occurs

In tissue aleady irritated inflamed, eg. Around partialy

Erupted teeth or due to lowered body immunity .

Diffuse or Marginal Erythema the gingiva and other

Oral tissue become intensely red and sensitive and lymph

gland enlarged.

Acute Candidasis ( Moniliasis or Thrush)

mucosa Most common mycotic oral infection

Overgrowth of candida Albicans

1. Alleviated resistance to infection

E.g. prolonged antibiotic therapy

Xerostomia

Poor oral hygiene

2. Compromised immune system E.g. AIDS

Corticosteroids therapy.

Early infancy

3. Generalized patient debilitation E.g.

Uncontrolled diabetes

Anemia

Advanced systemic diseases

Clinical Features

Characterized by crudy white area on the oral

mucosa that is adherent.

When forcibly wiped off leave a red bleeding surface?

Diagnosis

1. History

2. Clinical finding

3. Smear & biopsy

4. culture

Management

1. Nystatin suspension (100,000 Iu)

1 tsp. - held in the mouth for 5 minutes and then swallowed,

repeated four times a day.

2. AmphotericinB 10mg tablet

3. Clotrimazole troches

APHTHOUS STOMATITIS

Idiopathic, noninfectious, inflammatory disease

characterized by recurrent ulcers involving non

keratinized oral mucosa.

Aphthous stomatitis occurs as

-Occasional aphthae

-Acute aphthae

-Recurrent aphthae

Etiology is unknown

Predisposing factors

Hormonal disturbances

Allergic phenomena

Gastrointestinal disorders

Psychosomatic

Clinical Features

They are usually circular ulcers less than 1 cm in diameter.

Have light yellow central area surrounded by prominent

band of erythema.they are usually painful

Occurs in the oral cavity any where except the

attached gingiva, hard palate and lips

Management

1. Tetracycline M. wash.

2. Hydrocortisone acetate ointment 0.5% or

betametazone ointment o.1%

3. O.2% chlorhexidine as m. wash

Acute Necrotizing Ulcerative Gingivitis

A.N.U.G. is an inflammatory destructive disease

of the gingiva presents characteristic

clinical signs and symptoms.

Necrotizing gingivitis

Necrtizing gingivitis ; necrotizing periodontitis & N. stomatitis

They rapidly destructive and debilitating, and they appear

to represent various stages of the same disease process.

Etiology:

Unknown

Certain bacterial strains has been incriminated

Spirochaetal organisms and Fusiform bacilli

Predisposing Factors

local

Systemic

Psychosomatic factors

Clinical Feature

CLINICAL FEATURES

It can be classified as

ACUTE, SUBACUTE OR RECURRENT.

It affects elders. Relatively uncommon in children.

No definitive duration.

History- Sudden onset sometimes followed an episode of

debilitating disease or acute respiratory tract infection.

Oral signs

Characteristic lesions are

PUNCHED OUT CRATER LIKE DEPRESSIONS at crest of

interdental popilla, subsequently extend to marginal gingiva.

The surface of the gingival craters is covered by grey pseudo-

membranous sloughs demarcated from the rest of the gingiva by a

linear erythema.

Spontaneous gingival hemorrhage.

Fetid odor.

Increased salivation.

It may progressively destroy gingiva and underlying periodontal

tissues

Oral symptoms

Lesions extremely sensitive to touch.

Constant radiating gnawing pain.

Metallic foul taste.

Excessive ‘pasty’ saliva.

Extraoral signs and symptoms

Local lymphadenopathy and slight elevation in temp. in mild and

moderate cases.

In severe cases, marked systemic complications.

In rare cases, NOMA, fusospirochetal meningitis, peritonitis,

pulmonary infection, toxemia, fatal brain abscess.

Diagnosis: based on clinical finding and history.

Differential Diagnosis:

1. Streptococcal gingivo-stomatitis.

2. Gonococal stomatitis.

3. Vincent's angina

4. Agranulocytosis.

5. Acute herpetic gingivo-stomatitis.

Management

TREATMENT

Alleviation of acute symptoms

first complete patient’s information, general and systemic.

Complete intraoral examination and bacterial smear if require.

Local treatment should be in orderly sequence.

For non-ambulatory patients, vigorous treatment should not be

undertaken until systemic symptoms subside.

General removal of necrotic pseudomembrane with cotton pellet

saturated with H2O2 (hydrogen peroxide). Superficial scaling with

ultrasonic scalers first. Later scalers and curettes are used after some

days of gingival shrinkage.

Systemic orally, one of the following is usually given.

PENICILLIN –250 or 500mg 6 hourly for 5-7 days.

For penicillin sensitive patients ERYTHROMYCIN 250 or 500mg 6

hourly for 5-7 days.

METRANIDAZOLE 250 or 500mg 8 hourly for 5-7 days.

Supportive treatment – fluids, analgesics, nutritional supplements.

After the acute condition subsides, recontour gingiva (gingivoplasty)

Instructions to ANUG patient

Avoid alcohol, tobacco, and condiments.

Rinse with equal amounts of water and 3%

H2O2 every 2 hours.

Avoid excessive physical exertion.

Use soft toothbrush with bland dentrifice.