April 06, 2008
Gingivitis is relatively a rare condition and is characterized clinically by necrosis of the free gingival margin, the crest of the gingiva and the inter dental papillae etc.
Etiology:
Ulcerative gingivitis is a fusospirochetal disease and is caused predominantly by the fusiform bacilli and a spirochete called Borrelia vincenti.
Precipitatitng Factors:
- Sudden change in lifestyle
- Poor oral hygiene
- Lack of rest and sleep
- Local tissue damage
- Debilitating disease (viz. infectious mononucleosis, bacterial infection, diabetes, blood dyscrasias etc.)
- Emotional stress
- Down’s syndrome
- Smoking
Clinical Features:
- Ulcerative gingivitis usually occurs between the age of 15-35 years and males are to get infected more than females.
- Initially the gingiva becomes red and painful
- Erosion of the inter dental papillae occurs
- Gingiva is open covered by a “pseudo-membrane” and it has a pronounced bleeding tendency and produces extremely unpleasant fetid odor.
- Rarely gingiva lesion may extend to the mucosal surfaces of soft plate and tonsils
- Patients often develop headache, fever, malaise and lymphadenopathy etc.
- Difficulty in taking food due to increased salivation and a metallic test in the mouth
- Most of the patients develop systemic manifestations in the form of leukocytosis, tachycardia and gastro-intestinal disturbance etc.
Histopathology:
- The gingival tissue shows inflammation and extensive necrosis
- The stratified squamous epithelium is often replaced by a “pseudomembrane”
- The pseudomembranee usually consists of micro organism polymorphonuclear neutrophil and necrotic tissue debris etc.
- The unaffected areas of the gingival tissue shows a general lack of keratinization.
Treatment:
- Local debridement of necrotic tissue with hydrogen peroxide
- Administration of Metronidazole.
