Necrotizing Periodontal Disease

Necrotizing periodontal diseases are included in the seven categories of periodontitis that were classified by the American Academy of Periodontology in 1999, and they were also included among the three classifications included in the 2017 updated classification. Necrotizing periodontal diseases are caused by bacteria, specifically fusobacteria and spirochaete types, and appear to represent a single disease process with differing stages, or levels of severity. Necrotizing periodontal diseases may appear suddenly and may therefore be defined as acute. The most mild form of necrotizing periodontal disease is necrotizing ulcerative gingivitis. Necrotizing ulcerative periodontitis is more severe and is surpassed in severity by necrotizing stomatitis. The most severe form of necrotizing periodontal disease is cancrum oris, also called noma, which is usually fatal. Necrosis is defined as the localized death of cells; necrotizing diseases kill cells in a given area.

Necrotizing ulcerative gingivitis is common and not contagious. The disease commonly presents as acute and, if improperly treated, may develop into a chronic or recurrent disease. Acute necrotizing ulcerative gingivitis in developed countries occurs primarily in young adults with risk factors that include stress, sleep deprivation, malnutrition, smoking, immunosuppression, and poor oral hygiene. In developing countries, acute necrotizing ulcerative gingivitis is present mostly in malnourished children. Because of the possibility of shared predispositions in specific populations, acute necrotizing ulcerative gingivitis may appear in patterns that resemble epidemics; this has led some people to believe that the condition is contagious, but it is not. Necrotizing ulcerative gingivitis is characterized by bleeding gums and painful ulceration and destruction of the gingival tissue between the teeth. Other symptoms may include bad breath, swollen lymph nodes in the neck, and a general feeling of discomfort or unease. Necrotizing ulcerative gingivitis, especially in its acute form, is treated with a dual therapy of dental debridement and antibiotics. Predisposing factors, including but not limited to poor oral hygiene, may also need to be addressed. Because it was observed to occur frequently among soldiers in World War I, necrotizing ulcerative gingivitis is also known as trench mouth.

Necrotizing ulcerative periodontitis, which also appears in an acute form, exists when there is attachment loss in the gingiva, the periodontal ligament, and the alveolar ligament, caused by infection. It is widely believed that necrotizing ulcerative periodontitis is a progression of necrotizing ulcerative gingivitis, though this has not been proven. Because necrotizing ulcerative gingivitis also tends to lead to attachment loss, the two diseases may be named interchangeably. Both are classified as necrotizing periodontal diseases.

If allowed to progress into the tissue beyond the mucogingival junction, necrotizing ulcerative periodontitis may develop into necrotizing stomatitis. Beyond this progression, cancrum oris, or noma, develops. Cancrum oris is a destructive infection that necrotizes the cells of the mouth and the face. It is therefore not exclusively a periodontal disease, though it is believed to develop from pre-existing necrotizing ulcerative gingivitis. Cancrum oris usually occurs only in malnourished children in developing countries. It is often disfiguring and usually fatal. While cancrum oris is believed to develop from necrotizing ulcerative gingivitis, a significant majority of necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis cases do not progress into necrotizing stomatitis or cancrum oris, even when left untreated.