NECROTIZING PERIODONTAL DISEASES
Necrotizing ulcerative gingivitis (previously called acute necrotizing ulcerative gingivitis, Vincent’s infection, or trench mouth) and necrotizing ulcerative periodontitis represent a spectrum of acute inflammatory disease starting with destruction limited to the soft tissues (gingivitis) and extending to destruction of the alveolar bone and periodontal ligament (peri-odontitis). This disease spectrum is distinctly different from gingivitis – chronic periodonti-tis. It has an acute onset, frequently associated with periods of stress and poor oral hygiene. There is rapid ulceration of the interdental areas of the gingiva, resulting in destruction of the interdental papillae. The inflammatory condition initially confined to the gingival tissues can quickly extend into pathologic bone resorption. Unlike gingivitis and chronic periodon-titis, acute necrotizing periodontal disease is painful. As the oral epithelium is destroyed, the causative bacteria come into direct contact with the underlying tissues and may invade them. Spirochetes and fusiform bacteria have been implicated; thus, the term fusospiro-chetal disease has been used to describe this infection, which can also be manifested as ul-ceration in other areas of the pharynx or oral cavity. Prevotella intermedia has also been found in high numbers in the lesions. Morphologic studies have shown that the spirochetes actually appear to invade the tissues. The disease may be treated with systemic antibiotics and topical antimicrobials for immediate relief of symptoms, but resolution is dependent on thorough professional cleaning of the teeth and institution of good home care.