Abstract
Introduction: Necrotising ulcerative gingivitis (NUG) is a microbial disease characterized by the death and sloughing of gingival tissue. This article presents a classic case with characteristic symptoms of gingival necrosis, punched out ulcerated papillae, pseudomembrane formation and pain. Case Report: The patient was treated with the conventional treatment modalities of antimicrobial treatment, swabbing of the pseudomembrane with H2O2 followed by irrigation at home mouth rinses. A soft toothbrush was advised without any adjunctive toothpaste. Additionally, ozone therapy was done on the 3rd day since the lesion persisted. Each arch was ozonated for five minutes using custom made silicon stents with nozzle in the front to allow the ozone generator to pass through. With adjunctive ozone therapy lesions had started to resolve by the 5th day and the patient was also relieved of all associated symptoms. Conclusion: Elimination of the bacteria is a very important part of treatment of NUG. Treponema, bacteroides intermedius and fusobacterium species are the principle bacteria involved in the disease. These bacteria are essentially anaerobic. Ozone therapy creates an aerobic environment for these bacteria inhibiting their growth and disrupting the integrity of the bacterial cell wall by oxidation and inactivating the existing bacteria. Ozone therapy does not damage the other surrounding healthy cells. These healthy cells have a coating of enzymes like catalase, glutathione perioxidase, reductase and superoxide dimutase which prevents the oxygen radical from penetrating them. Hence using ozone as an adjunctive therapy helps accelerate healing and treat the basic etiology in a very targeted manner.
Highlights
Necrotising ulcerative gingivitis (NUG) is a microbial disease characterized by the death and sloughing of gingival tissue
Necrotizing ulcerative gingivitis is different from the other periodontal diseases, in that it presents with interdental gingival necrosis leading to “punched out” ulcerated papillae, spontaneous gingival bleeding and pain with pseudomembrane formation [2, 3]
The antibiotics and oxygenating agents are thought to eliminate the bacterial etiology, while vitamin therapy acts as an adjunct to overcome nutritional deficiencies
Summary
Necrotizing ulcerative gingivitis (NUG) is a distinct and specific disease which is rapidly destructive, noncommunicable and of complex etiology. Conventional treatment of NUG involves oral hygiene reinforcement, mechanical debridement of plaque, vitamin and diet therapy, oxygenating agents, holistic care, and administration of antibiotics and their various combinations [5]. The antibiotics and oxygenating agents are thought to eliminate the bacterial etiology, while vitamin therapy acts as an adjunct to overcome nutritional deficiencies. Ozone is a triatomic molecule consisting of three oxygen atoms and is widely used in medicine and dentistry due to its antimicrobial, antihypoxic, analgesic and immunostimulating effects on the biological systems [11] This case report demonstrates the apparent beneficial use of topical ozone application in a patient with NUG. Asnani et al 2 revealed that the patient was undergoing emotional stress and was suffering from sleep deprivation due to her upcoming examinations Her oral hygiene was fair with slight plaque accumulation and halitosis. Scaling and root planing was done on fifth day (Figure 6A–C)
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