Periodontics › Pathology
Necrotising Ulcerative Gingivitis & Herpetic Infections
High-yield revision notes with linked practice questions, written for dental students and candidates preparing for the ADC and other licensing examinations.
High-yield notes
ANUG is also known as Vincent's infection or Trench Mouth.
ANUG is characterized by the death and sloughing of gingival tissue, starting from interdental papilla
There is no chronic form of acute necrotizing ulcerative gingivitis.
Spirochetes have been found as deep as 300 µm from the necrotic surface.
Treatment of a case of herpes with the debridement required for NUG could exacerbate herpes.
There is no pocket formation in ANUG as there is no viable junctional epithelium.
The constant flora associated with NUG is composed of Prevotella intermedia, in addition to Fusobacterium, Treponema, and Selenomonas species.
NUG is most often associated with stress and smoking.
NUG is more common in children with Down syndrome than in other children with mental deficiencies.
NUG is more common in children from low socioeconomic groups in underdeveloped countries.
The main reason for the increased incidence of NUG in World-War is stress.
Herpes virus persists as latent HSV in neuronal ganglia that innervate the site, after primary infection.
The course of the primary herpetic gingivostomatitis is limited to 7 to 10 days.
Scarring does not occur in the areas of healed herpetic ulcerations.
A history of previous episodes of painful mucosal ulcerations suggests RAS rather than primary HSV.
Most adults have developed immunity to HSV as the result of infection during childhood, which in most cases is subclinical. For this reason, acute herpetic gingivostomatitis usually occurs in infants and children.
The partially erupted or impacted mandibular third molar is the most common site of pericoronitis.
Periodontal probing of NUG lesions is likely to be very painful and may need to be deferred until after the acute lesions are resolved.
Antibiotics are not recommended in NUG patients who do not have systemic complications.
For ANUG patients, rinse with a glassful of an equal mixture of 3% hydrogen peroxide and warm water every 2 hours.
Herpetic infection of a clinician's finger, referred to as herpetic whitlow, can occur if a seronegative clinician becomes infected with a patient's herpetic lesions.
For ANUG, systemic antibiotics are only used if there is evidence of lymphadenopathy or spread beyond the gingiva, except they are always used in immunocompromised patients such as those diagnosed as HIV positive.
Acute gingival lesions that do not respond to treatment within 2 weeks should be biopsied to secure the correct diagnosis.
The term chronic desquamative gingivitis was coined in 1932 by Prinz.
Desquamative gingivitis is only a clinical term, not a diagnosis.
Practice questions
Select an option to check your answer. Answers are shown below each question.
A patient comes to the department with a punched out crater like lesion on the interdental papillae. On radiographic examination, there is an evidence of crestal bone loss. Most probable diagnosis is
- AJuvenile periodontitis
- BAcute necrotizing ulcerative gingivitis
- CAcute necrotizing ulcerative periodontitis
- DAggressive periodontitis
The surface of the gingival craters is covered by a gray, pseudomembranous slough, demarcated from the remainder of the gingival mucosa by
- AMucogingival junction
- BLinea alba
- Clinear erythema
- Douter projection of the gingival sulcus
True about ANUG is
- APocket formation
- BViable junction epithelium
- CRare in edentulous mouth
- Dextremely sensitive to touch
The pseudomembrane in ANUG is composed of all except
- Anecrotic epithelial cells
- Bpolymorphonuclear leukocytes (PMNs, neutrophils)
- Clymphocytes
- Dmicroorganism
Predominant organism associated with ANUG
- AA. actinomycetemcomitans
- BFusospirochetes
- CVibrios
- DGram negative rods
Lesions seen in ANUG differs from the lesions of agranulocytosis in that
- Anecrosis of the gingiva is present in ANUG only
- BAgranulocytosis lacks the severe inflammatory reaction seen in ANUG
- Cnecrosis of the gingiva is present in agranulocytosis only
- DANUG lacks the severe inflammatory reaction seen in Agranulocytosis
Vitamin deficiency associated with NUG is
- AVit-B1
- BVit-B2
- CVitamin A
- DVit-B12
NUG is
- ATransmissible but not communicable
- BCommunicable but not transmissible
- CTransmissible and communicable
- DNeither transmissible nor communicable
In ANUG, there is
- ANo pocket, no bone loss
- BBone loss without pocket formation
- CPocket formation without bone loss
- DBoth pocket and bone loss
Untrue about primary herpetic gingivostomatitis is
- Aoccurs most often in infants and children younger than 6 years of age
- BOccurs with equal frequency in male and female
- Cthe primary infection is very painful in most of the cases
- Dcaused by the herpes simplex virus type 1 (HSV-1)
Which of the following is not the type of secondary manifestation of herpes?
- Aherpes genitalis
- Bocular herpes
- Cherpetic encephalitis
- Dherpetic endocarditis
primary herpetic gingivostomatitis is not characterized by
- Aballooning degeneration
- BTzanck cells
- CAcanthosis
- DMultinucleated cells
Which of the following is not seen in case of pericoronitis?
- Afoul taste
- BTrismus
- CLymphoma
- DSwelling of the cheek
Most common complication of pericoronitis is
- Apericoronal abscess
- BPeritonsillar abscess formation
- CCellulitis
- DLudwig's angina
Acute necrotizing ulcerative gingivitis is also called as
- AVincent's angina
- BVincent's infection
- CVincent's ulceration
- DVincent's gingivitis
Which of the following is not recommended in the initial visit of the ANUG?
- APeriodontal probing
- BRemoval of pseudomembrane and nonattached surface debris
- CRemoval of superficial calculus
- Dcleaning with warm water
Procedures such as extractions or periodontal surgery for ANUG patients,
- ACan be carried out once the patient is symptom free
- BCan be carried out once the patient is symptom free for at least 1 week
- CCan be carried out once the patient is symptom free for at least 2 weeks
- DCan be carried out once the patient is symptom free for at least 4 weeks
The second visit is made
- A1-2 days after the first visit
- B4-5 days after the first visit
- CA week after the first visit
- D2 weeks after the first visit
Subgingival scaling in the treatment of ANUG is done,
- AAt the first visit
- BAt the second visit
- CAt the third visit
- DShould never be done
At the 3rd visit of treatment,
- Acomprehensive plan for the management of the patient's periodontal conditions is formulated.
- Bhydrogen peroxide rinses are continued, but chlorhexidine rinses are discontinued.
- Croot planing may lead to exacerbation of the disease
- Dall of the above
Shelflike gingival margin seen as a consequences of ANUG,
- AFormed, if there has been loss of facial and lingual bone in an unequal proportion
- BFormed, if there has been loss of facial and lingual bone in an equal proportion
- Cfavors retention of plaque
- DHas no esthetic significance.
Not an option for the treatment of ANUG,
- AMetronidazole
- Bsilver nitrate
- Cvitamin supplements
- Dhydrogen peroxide
Which of the following is not the cause of the recurrence or refractory NUG in the mandibular anterior area?
- AInadequate removal of calculus and other local factors
- BInadequate local therapy
- Cpersistent pericoronal inflammation of third molars
- DAll are the causes of recurrence or refractory NUG in the mandibular anterior area.
Persistent symptom-free pericoronal flaps
- AShould be removed as a preventive measure against subsequent acute involvement.
- BRequires close monitoring
- CIndicates extraction of the involved tooth as preventive measure
- DShould be irrigated and cleansed every month.
Untrue about the pericoronal flap,
- AIt is necessary to remove the tissue distal to the tooth, as well as the flap on the occlusal surface.
- BIt is not necessary to remove the tissue distal to the tooth, as it may cause unnecessary trauma to the patient.
- CDone once the acute phase subsides
- DDone only when the tooth is planned to retain.
A 6 years old immunocompetent child patient presents with pain, difficulty in eating and diffuse erythema of the entire gingiva accompanied by fever since 4 days. Which of the following treatment modality is not an appropriate treatment modality?
- Aacyclovir therapy
- BNSAID (e.g., ibuprofen)
- Ctopical anesthetics before eating
- Dremoval of plaque and food debris
Which of the following is not the characteristic feature of desquamative gingivitis?
- Adesquamative gingivitis was not a specific disease entity
- BPatients may be asymptomatic
- Cmild burning sensation to an intense pain
- Dprimary herpetic gingivostomatitis is one of the cause
The reshaping process of the gingiva in the absence of the periodontal pocket is
- Acurettages
- Bgingivoplasty
- Cgingivectomy
- Dflap operation
Gingival deformities due to the fixed orthodontic treatment can be corrected by
- Acurettages
- Bgingivoplasrty
- Cgingivectomy
- Dall of the above
Gingivoplasty is more likely to be useful in
- AANUG
- BJuvenile periodontitis
- CDesquamative gingivitis
- DAll of the above
These notes are compiled from standard periodontology texts for study purposes. They are a revision aid, not a substitute for your own reading or current clinical guidelines. If you spot an error, please leave a comment.