Necrotizing periodontal disease
The workshop recognized that necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative peridontitis (NUP) were clinically distinguishable disease entities but were unsure as to whether they were part of the same disease process or were two distinct diseases. They concluded that there was insufficient data to resolve this problem, thus they decided to place both conditions in the one category of “necrotizing periodontal disease”.36 Certainly clinical observation would suggest that they are part of a continuum with initial infections perhaps showing little or no clinically recognizable attachment loss despite soft tissue destruction of the papillary tissue. However, with recurrent infections, to which these patients are prone, the attachment loss becomes more apparent. Figure 13 shows necrotizing ulcerative gingivitis in a 21-year-old law student taken during his final year examinations. This patient was under stress, was smoking tobacco heavily and had a history of “bleeding gums” (pre-existing gingivitis). These are common predisposing factors for necrotizing periodontal disease. He complained of painful gingival tissues, of sudden onset. Note the marked gingival erythema and oedema, loss of papillary tissue with punched out crater ulcers and spread of the ulceration to the marginal tissue with obvious bleeding. Necrotizing ulcerative gingivitis tends to be recurrent if predisposing factors remain and progresses to necrotizing ulcerative periodontitis, in some cases causing severe destruction of the periodontal tissues (Fig 14). This condition is commonly associated also with HIV infection (Fig 12) and because of this there has been some discussion as to whether it should be included under manifestation of systemic diseases. However, it is likely that HIV acts as a predisposing factor by lowering host resistance.
โรคเหงือกโรค necrotizingThe workshop recognized that necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative peridontitis (NUP) were clinically distinguishable disease entities but were unsure as to whether they were part of the same disease process or were two distinct diseases. They concluded that there was insufficient data to resolve this problem, thus they decided to place both conditions in the one category of “necrotizing periodontal disease”.36 Certainly clinical observation would suggest that they are part of a continuum with initial infections perhaps showing little or no clinically recognizable attachment loss despite soft tissue destruction of the papillary tissue. However, with recurrent infections, to which these patients are prone, the attachment loss becomes more apparent. Figure 13 shows necrotizing ulcerative gingivitis in a 21-year-old law student taken during his final year examinations. This patient was under stress, was smoking tobacco heavily and had a history of “bleeding gums” (pre-existing gingivitis). These are common predisposing factors for necrotizing periodontal disease. He complained of painful gingival tissues, of sudden onset. Note the marked gingival erythema and oedema, loss of papillary tissue with punched out crater ulcers and spread of the ulceration to the marginal tissue with obvious bleeding. Necrotizing ulcerative gingivitis tends to be recurrent if predisposing factors remain and progresses to necrotizing ulcerative periodontitis, in some cases causing severe destruction of the periodontal tissues (Fig 14). This condition is commonly associated also with HIV infection (Fig 12) and because of this there has been some discussion as to whether it should be included under manifestation of systemic diseases. However, it is likely that HIV acts as a predisposing factor by lowering host resistance.
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