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Necrotising periodontal diseases

Figure 38.1 (a–c) Necrotising ulcerative gingivitis showing marked necrosis and typical punched out interdental papillae between the maxillary incisors and between the mandibular right lateral and canine.

Figure 38.2 Sloughing and pseudomembrane interdentally in the maxillary incisor region.

Figure 38.3 (a–c) Following the acute phase, the symptoms have settled down in this 27-year-old male smoker, but there is evidence of: (i) interdental necrosis and punched out papillae in the maxillary and mandibular anterior regions; (ii) gross deposits of subgingival calculus which are now located supragingivally due to apical migration of the gingivae; and (iii) detachment of the buccal gingiva from the mandibular incisors, indicating clinical attachment loss has occurred (i.e. destruction of the periodontal ligament. This indicates a transition from NUG to NUP.

Figure 38.4 (a, b) A male patient with HIV/acquired immune deficiency syndrome (AIDS), and NUP leading to necrosis of the palatal tissue on the maxillary central incisor exposing the underlying palatal alveolar bone.

Figure 38.5 Necrotising ulcerative periodontitis-like lesions on the lower incisors in a 15-year-old girl who used cocaine orally. Local application to the gingival tissue causes inflammation, recession, necrosis of the underlying bone and, in due course, recession. Courtesy of Professor I. L. C. Chapple.

Figure 38.6 Differential diagnosis between NUG and primary herpetic gingivostomatitis.

Figure 38.7 (a) Lymphadenopathy in child with primary herpetic gingivostomatitis. (b) Fiery red gingival inflammation and swelling plus herpetic viral vesicles on the margin of the gingiva.

Figure 38.8 Herpetic vesicles on the tongue.

Figure 38.9 (a, b) Herpetic whitlow on a finger due to transmission of herpes simplex virus 1 from the mouth to a finger.

Following the 1999 International Workshop for the Classification of Periodontal Diseases and Conditions, it was recommended that necrotising ulcerative gingivitis (NUG) and necrotising ulcerative periodontitis (NUP) should be collectively call/>

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