The oral cavity is an entire ecosystem, a balanced microcosm that, under favorable external conditions, is an integral part of the digestive system. It is difficult to overestimate the importance of healthy teeth and gums, though people are increasingly faced with various oral disorders, and acute necrotizing ulcerative gingivitis is among them. The disease belongs to the group of infectious-inflammatory and, in the presence of provoking factors, develops on its own or can occur as a complication after an untreated catarrhal form. The purpose of this paper is to describe the disease’s nature and prominent symptoms, its course, and possible methods of medical intervention. It will contribute to understanding the peculiarities of the particular oral disease and the possibilities of its prevention or elimination. Acute necrotizing ulcerative gingivitis is one of the severe and rapidly developing conditions of the oral cavity, which can lead to serious consequences, and its timely diagnosis and treatment methods are crucial.
Acute necrotizing ulcerative gingivitis is not widespread but intense inflammation of the gums, with destruction and changes in the normal tissue contours, ulceration, and necrosis. Firstly, the grounds for the disease and the factors that influence it should be noted. Gingivitis is often caused by a parodontopathic myx-infection, a disease caused by multiple pathogens simultaneously (Khetarpal et al., 2019). Bacteria are always present in small numbers in the mouth of a healthy person, but when the equilibrium is upset, their numbers increase. An imbalance can occur, for example, if there is an abundance of plaque (Syam & Maheswari, 2019). It leads to a decrease in the redox potential of the gum tissue, which promotes the growth of pathogenic bacteria involved in the occurrence of ulcerative gingivitis.
The leading local causes of the disease are:
Poor oral hygiene. Plaque accumulates on the teeth, and colonies of pathogenic and opportunistic microorganisms, resulting in gingivitis.
- The presence of oral diseases. The ulcerative-necrotic form often develops as a complication of catarrhal gingivitis or stomatitis.
- Trauma to the gums due to complicated eruption of wisdom teeth, exposure to poor-quality fillings or dentures.
Furthermore, even severe stress or fatigue can cause ulcerative gingivitis. Patients with cardiovascular diseases, hormonal imbalances, and endocrine system diseases are at risk. Colds that weaken the immune system can likewise provoke the disease. People, who eat not enough, such as women on a strict mono diet, are prone to gingivitis (Khetarpal et al., 2019). However, one factor is usually not enough to develop an acute form of ulcerative and necrotic gingivitis, and there are always several provoking factors in most cases.
Unlike other oral diseases, acute ulcerative-necrotic gingivitis is rarely chronic. The disease develops quickly and rapidly, and its symptoms are very pronounced. Even in this case, patients do not always go to the doctor on time (Syam & Maheswari, 2019). The issue is that it has symptoms similar to other oral diseases, including non-dental ones. Nevertheless, it is necessary to pay attention to such factors:
The rapid development of severe swelling of the gums.
- The mucosa becomes red and extremely sensitive.
- Extreme, seldom going away pain, intensifying at the slightest pressure, temperature changes.
- Bleeding for no apparent reason.
On the surface of the gums, ulcerations develop, and the mucosa around them is covered with a pale fibrous plaque. Inside the lesions is a lymphocytic infiltrate, which may discharge into the oral cavity (Syam & Maheswari, 2019). If the process is neglected, necrosis of the gum tissues begins. The same signs characterize the chronic form, but unlike acute ulcerative-necrotic gingivitis, they are not pronounced. As a result, the patient, who is not experiencing severe problems, delays the visit to the doctor.
Therefore, acute necrotizing ulcerative gingivitis symptoms are similar to numerous other oral diseases. Only a doctor can make an accurate diagnosis and prescribe adequate treatment. An oral cavity examination is carried out during diagnosis, and tests are prescribed. If the process is advanced, X-rays are taken to evaluate whether the bone tissue is affected by necrotic processes (Siddiqui et al., 2020). Often the diagnosis of gingivitis requires examination by a few doctors of other specialties. It is impossible to delay the treatment of acute ulcerative and necrotic gingivitis because necrotic processes begin without adequate medical treatment (Siddiqui et al., 2020). The treatment program includes professional dental cleaning because before one begins any therapeutic manipulations, it is necessary to thoroughly clean the surface of the teeth from plaque and calculus.
Ulcers are treated with antiseptic solutions, and during the entire treatment of ulcerative-necrotic gingivitis, it is essential to rinse the oral cavity with an antiseptic solution, such as chlorhexidine. If required, the doctor prescribes antibiotics or anti-inflammatory drugs. Metronidazole is very effective for the treatment of the disease. If there are contraindications, penicillin may be prescribed instead (Siddiqui et al., 2020). Any pressure on the surface of the affected gum causes a sharp, almost unbearable pain. Painkillers are not a required part of the treatment program, but in most cases, they are prescribed. It reduces the pain’s severity and permits the patient to eat normally and maintain oral hygiene.
Thus, acute necrotizing ulcerative gingivitis is a painful gum infection. The disease is complicated because local and systemic factors can be catalysts. The primary symptoms are acute pain, sensitivity, bleeding, and bad breath. Treatment consists of gentle wound cleaning, improved oral hygiene, mouthwash, supportive care, and possibly pain medication or antibiotics. It is possible to cure the disease completely, but it is vital to seek help at the first signs of the disease because even in the later stages, the right therapy will allow you to achieve stable remission.
References
Khetarpal, S., Mhapsekar, T., Nagar, R., & Parihar, A. (2019). Oral histoplasmosis masquerading as acute necrotizing ulcerative gingivitis: A rare case report. International journal of health sciences, 13(5), 37.
Siddiqui, A. Z., Vellappally, S., Fouad, H., & Muckarrum, S. M. (2020). Bactericidal and clinical efficacy of photochemotherapy in acute necrotizing ulcerative gingivitis. Photodiagnosis and Photodynamic Therapy, 29, 101668. Web.
Syam, S., & Maheswari, T. N. (2019). Guidelines for clinical management of patients with acute necrotizing ulcerative gingivitis: A literature review. Research Journal of Pharmacy and Technology, 12(8), 4027-4030.