NUG
Symptoms of NUG (necrotizing ulcerative gingivitis)
- Enlarged lymph node
- Fever & malaise
- Hyper salivation
- Bleeding
- Fiery red gingiva, necrosis
- Punched out papillae
- Extreme pain
- Fetor oris
Four zones of NUG as shown by Listgarten
- bacterial zone
- neutrophil-rich (PMN) zone
- necrotic zone
- infiltration of spirochetes (250 um)
Etiologic factors of NUG
- malnutrition
- emotional stress
- smoking
- compromised immune system
- PMN defect
- HIV +
- young age
Treatment of NUG
- pain relief
- debride carefully (supragingival)
- topical antibiotics not useful
- PCN or metronidazole for 7 days if systemic symptoms are present
- NUG
- instructions
- rest, drink fluid,
avoid smoking & alcohol
nutritional supplement (Vit B, C)
rinse with H2O2 or CHX
brush & floss
- postpone all perio procedures
- antibiotic prophylaxis in case of emergency
- after healing, comprehensive perio exam & treatment
Healing of NUG lesions
- crater formation –> plaque trap: may require surgical revision
Do not use:
- phenol
- silver nitrate
- chromic acid
systemic antibiotics
- only in pt with toxic systemic complications or local adenopathy
- only to be used as an adjunc
Supportive systemic treatment
- fluid
- analgesics
- bed rest
- malaise, high fever, general debility
Nutritional supplements
- NUG may be caused by nutritional deficiency
- Difficulty in chewing
- Fewer recurrence with Vit B & C supplement
- therapeutic dose of Vit B & C
