Necrotizing Periodontal Disease

Necrotizing periodontal diseases are characterized by areas of necrotic tissue, or tissue that is dead or dying, among the other traits of periodontitis. Necrotizing periodontal diseases are included among the seven 1999 classifications of periodontal diseases. While necrotizing periodontal diseases are believed to be varying degrees of the same disease process, this has not been clinically proven; additionally, because these diseases often have a sudden onset, they are often described as acute. The least severe of the necrotizing periodontal diseases is necrotizing ulcerative gingivitis. This is followed, in order of severity, by necrotizing ulcerative periodontitis, necrotizing stomatitis, and, finally, by cancrum oris, which is also called noma and is frequently fatal.

In addition to being the least severe, necrotizing ulcerative gingivitis is relatively common and, like all periodontal diseases, is non-contagious. The primary difference between necrotizing ulcerative gingivitis and chronic periodontitis is the often-significant pain that can arise in the gum tissue when ulceration and necrotizing are present. If left untreated, necrotizing ulcerative gingivitis may become chronic, recurring frequently. Necrotizing ulcerative gingivitis is most prevalent in young adults with certain predisposing factors, such as sleep deprivation, malnutrition, smoking, immunosuppression, or malnutrition, combined with deficiencies in oral hygiene. The primary symptoms are bleeding, painful gums, and ulceration and destruction of the tissues of the gums. Other symptoms may include bad breath and swollen lymph nodes. Because of its prevalence among soldiers on the front lines in World War I, probably due to a combination of compromised hygiene combined with psychological stress, necrotizing ulcerative gingivitis is commonly known as trench mouth. Despite its rapid onset and the discomfort and damage it brings, the condition may resolve relatively quickly and cause minimal long-term damage. Treatment usually includes mechanical deep cleaning of the oral cavity and removal of necrotized, or dead, gingival tissue, accompanied by antibiotics. Patients may also be educated in more effective home hygiene habits, which must be adhered to in order to prevent recurrence.

Necrotizing ulcerative periodontitis, and its acute form, is characterized by attachment loss in the gingival tissue, the periodontal ligament, and the alveolar ligament. Necrotizing ulcerative gingivitis often leads to attachment loss, which can blur the lines of diagnosis; however, once attachment loss has occurred, the disease is defined as periodontitis. When necrotizing ulcerative periodontitis progresses into the tissues deeper in the oral cavity, it develops into necrotizing stomatitis, which shares many characteristics with cancrum oris.

Cancrum oris, also called noma, is a destructive infection that attacks the mouth and the face. Because it moves outside the oral cavity, affecting the face, it is not strictly a periodontal disease, though it does arise from periodontal disease. Cancrum oris is most likely to appear in developing countries and is most often found in malnourished children. It is often disfiguring and can also be fatal. It is believed that cancrum oris develops from necrotizing ulcerative gingivitis that remains untreated, but this has not been proven. It is also the case that a considerable majority of cases of necrotizing ulcerative gingivitis and periodontitis never progress to the more severe and debilitating diseases, regardless of treatment.