Ulcerative Gingivitis Research Articles

A case-control study of plasma ascorbate and acute necrotizing ulcerative gingivitis.

Data from animal studies and from studies of patients with acute necrotizing ulcerative gingivitis (ANUG) have provided suggestive evidence for an association between ascorbate deficiency and disease risk. Further, there is biological plausibility for such an association, due to the role of ascorbate in collagen synthesis and leukocyte function. A case-control study of plasma ascorbate and ANUG was performed on 60 patients with a history of ANUG infection and 60 age-race-sex-matched controls. No cases had had active lesions for at least two months prior to their vitamin assay to avoid any potential reduction of dietary intake of ascorbic acid due to the presence of painful mouth lesions. According to results obtained by use of a modification of the 2,4-dinitrophenylhydrazine method for determination of total plasma ascorbate, the mean and standard error of the mean of plasma ascorbate for all ANUG cases was 0.07 +/- 0.006 mmol/L; the mean for all controls was 0.10 +/- 0.006 mmol/L. Paired differences in plasma ascorbic acid concentrations between cases and controls were significantly different from zero (p less than 0.001). The unadjusted relative risk (RR) of ANUG as obtained by conditional logistic regression for subjects whose plasma ascorbic acid concentration was at or below the median value for controls, relative to subjects with higher values, was 7.3 (90% confidence interval, 3.0 - 17.4; one-sided p value less than 0.001). Patients with a history of ANUG ingested a daily average of 1.2 +/- 0.2 servings of dietary ascorbic acid, as compared with a daily average of 1.9 +/- 0.2 servings for healthy controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of acute necrotizing ulcerative gingivitis.

In the last 60 years, there have been approximately 50 studies of various suspected risk factors associated with acute necrotizing ulcerative gingivitis. Two thirds of these studies have been either surveys or case reports; nearly all the rest have been case-control studies. There have been only a few longitudinal and population-based studies, most of which were in high-risk populations. The findings of many studies pertain to gingivitis in general rather than in acute necrotizing ulcerative gingivitis in particular; the findings of other studies are based on small numbers or solely on case histories without the inclusion of control subjects. There are comparisons between the epidemiology of acute necrotizing ulcerative gingivitis as it occurs in military populations and the epidemiology of meningococcal meningitis (98-103). Both diseases have been reported in closed communities such as in young recruits away from home and in new surroundings. A temporal trend upward in disease frequency was described for both infections during World War II. Both infections appear to be characterized by low communicability, with no documented transmission by fomites or vectors. Furthermore, active disease in both cases is associated with markedly increased numbers of normally indigenous flora: B. intermedius in the case of acute necrotizing ulcerative gingivitis and Neisseria meningococcus in the case of epidemic meningococcal meningitis. Risk factors associated with both diseases include crowding, physical fatigue, increased stress, low socioeconomic status, and failure of host defense mechanisms. In general, there is potential for longitudinal studies of young people such as new military recruits and college students who are undergoing the transition from dependence to independence. It is intriguing that these young adults are suddenly at increased risk of this disease in late adolescence when they should be at peak fitness and, just as suddenly, at decreased risk after their early thirties. It appears that the dynamic tension between bacterial agents, environmental stressors, and host defense mechanisms is abruptly altered in certain young people, allowing the characteristic lesions to develop. Furthermore it appears that, in the United States at least, the disruption is limited primarily to white people relative to black people. It is possible that disease develops because young adults are brought together from diverse locations and perhaps exposed to a new microbial agent. However, acute necrotizing ulcerative gingivitis has not been demonstrated clearly to be transmissible, and if it is, the mode of transmission is not known.(ABSTRACT TRUNCATED AT 400 WORDS)

Oral lesions in rhesus monkeys associated with infection by simian AIDS retrovirus, serotype-I (SRV-1)

Simian acquired immunodeficiency syndrome (SAIDS) is a retrovirus-induced immunodeficiency disease that affects certain nonhuman primates and has many parallels to human AIDS. We examined 72 rhesus monkeys ( Macaca mulatta) exposed to SAIDS retrovirus serotype-1 (SRV-1) and 81 healthy control monkeys at the California Primate Research Center to determine the prevalence of oral lesions. At the time of examination, 69 of the 72 monkeys exposed to SRV-1 had serologic and/or virologic evidence of SRV-1 infection. None of the 81 control monkeys had any evidence of infection with SRV-1. Acute necrotizing ulcerative gingivitis (ANUG), oral yeast infections, and noma occurred in 10% ( p < 0.01), 4%, and 1%, respectively, of the study group of 72 animals but were found in none of the control animals. Thus, ANUG occurs rather frequently in rhesus monkeys with evidence of SRV-1 infection. The reproducible immunodeficiency that follows inoculation of SRV-1 in rhesus monkeys promises to be a useful model for studying the pathogenesis of ANUG associated with immunodeficiency.

Subinhibitory concentrations of tetracycline alter fibrinogen binding by Bacteroides intermedius.

Previous studies from our laboratory have shown that a strain of Bacteroides intermedius, VPI 8944, an organism isolated originally from a patient with acute necrotizing ulcerative gingivitis, binds human fibrinogen rapidly, reversibly, specifically, saturably, and with high affinity (M.S. Lantz, L.M. Switalski, K.S. Kornman, and M. Höök, J. Bacteriol. 163:623-628, 1985). We examined the effect of growth in subinhibitory levels (sub-MICs) of tetracycline on fibrinogen binding by these bacteria and found concentration-dependent inhibition of fibrinogen binding by bacteria grown in the presence of tetracycline over the range of tetracycline concentrations from 1/64 to 1/8 the MIC. Analysis of the binding data suggests that bacteria grown in the presence of sub-MICs of tetracycline bind fewer fibrinogen molecules per cell than do bacteria grown in the absence of the drug. If fibrinogen-mediated adherence is important in the establishment B. intermedius in periodontal lesions and lesions of acute necrotizing ulcerative gingivitis, then tetracycline may be effective in disrupting establishment of these organisms at concentrations well below those required to achieve a bacteriostatic effect.

Fusospirochetal ulcerative gingivitis in children

Fusospirochetal ulcerative gingivitis in children

Hyaluronic acid and hyaluronidase activity in gingival exudate from sites of acute ulcerative gingivitis in man

Gingival exudates from sites of acute ulcerative gingivitis (AUG) and chronic gingivitis (CG) in adults were investigated by cellulose-acetate electrophoresis for the hyaluronic acid (HA) content and assayed for the levels of HA-degrading enzymes. HA was the only glycosaminoglycan (GAG) in gingival exudate from CG sites. HA was not detected at untreated AUG sites but was evident, at increasing levels. after two and seven days of effective antibacterial treatment. In AUG exudates, the total HA-degrading enzyme activity, of bacterial origin, decreased to approx. 30 and 10 per cent of the high initial levels after two and seven days of treatment respectively, to that level found at sites of CG. The specific activity of HA-degrading enzyme of lysosomal origin was low initially and increased with treatment to a level comparable to CG. The notable absence of HA from gingival exudate from sites of untreated AUG thus appears to result from the increased levels of bacterial hyaluronidase. Electrophoresis of gingival exudate may be an indirect method of monitoring the rate of response of AUG to different antibacterial treatments.

Interactions of Bacteroides gingivalis with fibrinogen.

Results of previous studies from our laboratory have shown that a strain of Bacteroides intermedius isolated originally from a patient with acute necrotizing ulcerative gingivitis binds and degrades human fibrinogen (M.S. Lantz, L.M. Switalski, K.S. Kornman, and M. Hook, J. Bacteriol. 163:623-628, 1985). We report that strains of Bacteroides gingivalis, an organism implicated in the etiology of several forms of periodontitis, also bind and degrade fibrinogen. The binding is rapid, reversible, saturable, and specific. The number of fibrinogen-binding sites per cell varies from 500 to 1,500 in different batches of bacteria, and the dissociation constant for the complex is on the order of 10(-8) M. B. gingivalis possesses cell-associated fibrinogenolytic activity that is activated by dithiothreitol and blocked by thiol protease inhibitors. Interaction with fibrinogen may mediate colonization and establishment of these organisms in the periodontal microbiota.

Inflammatory cells and bacteria in pericoronal exudates from acute pericoronitis

The present work is one in a series of studies carried out to verify the relationship between bacteria and gingival tissues in pericoronitis. Exudates from 6 cases of acute pericoronitis were examined by light and electron microscopy, including ultrathin sections and negative staining. While bacterial phagocytosis was prevalent in all the exudates studied, spirochetes, which were the predominant microorganisms, were not observed being phagocytized by PMNs or macrophages. The presence of spirochetes in pericoronitis as compared with acute necrotizing ulcerative gingivitis is discussed.

Metronidazole.

Metronidazole was introduced to the market in 1959 as the only effective therapy for Trichomonas vaginalis. A nitroimidazole derivative, its success in the therapy of parasitic infections, including Entamoeba histolytica and Giardia lamblia, has been well documented. Metronidazole's activity against anaerobic bacteria was first described in 1962 by Shinn, and by Davies and associates in 1964. In both reports, metronidazole effectively treated patients with Vincent's angina (necrotizing ulcerative gingivitis). Metronidazole's excellent activity against anaerobes has been substantiated by numerous articles. It has the best bactericidal activity of all drugs active against anaerobic bacteria.

Peripheral blood phagocyte function in acute necrotizing ulcerative gingivitis

Eleven patients suffering from acute necrotizing ulcerative gingivitis (ANUG) and 11 healthy controls, were analyzed for: 1) peripheral blood polymorphonuclear leukocyte (PMN) chemotaxis; 2) monocyte chemotaxis; 3) PMN phagocytosis; and 4) PMN intracellular killing A modification of the Boyden chamber technique was developed to determine in vitro cellular migration in test and control groups. Nitroblue tetrazolium (NBT) reduction and a candidacidal assay were used to investigate PMN phagocytosis and intracellular killing. Ten of the patients with ANUG were found to have depressed PMN chemotaxis. The difference, compared to control subjects, was significant at the 95% confidence level. The impaired chemotaxis of PMN was due to an intrinsic defect in the cells themselves, as abnormal levels of cell‐directed chemotactic inhibitors, inactivators of chemoattractants, or complement‐derived chemoattractants were not demonstrated in the serum of the patients with ANUG. Monocyte chemotaxis was enhanced in one of the ANUG patients. No differences were found between ANUG patients and controls in PMN reduction of NBT and intracellular killing. Four of the 11 ANUG patients were re‐examined 18 months later, when they were free of the symptoms of ANUG. None of the subjects demonstrated impaired neutrophil chemotaxis at this point, indicating that the defect may be a transient one associated in time with the ANUG episode.

Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment.

Vincent's original description of the fusiform-spirochete nature of acute necrotizing ulcerative gingivitis (ANUG) still remains true today, although much additional insight has been gained regarding the etiology, pathogenesis and treatment of the disease. In addition to the historic association of fusiform and spirochete microbes with ANUG, recent findings have also implicated Bacteroides and Selenomonas species. Possible abnormalities in immunological function, such as altered PMN and lymphocyte responsiveness, may be present. Stress, which has long been known to be associated with the disease, appears to play a role through induction of increased cortisol and catecholamine levels. These chemical mediators respectively may compromise the host immune responses and the gingival microcirculation. Cortisol may also serve as a nutrient source for Bacteroides bacteria. Other predisposing factors to ANUG may include smoking and poor oral hygiene. Treatment modalities involve eliminating or reducing the levels of bacterial pathogens by mechanical and antibiotic means, along with attempts at controlling significant psychological and physical precipitating factors.

Suit the word to the action

Language, like bone, is labile. Over the generations we recognize changes in word form, spelling, and even meaning in response to semantic pressures. Let, in Elizabethan times meaning an obstacle (surviving as let or hindrance), now denotes the opposite sense of permission. Prorogue, burdened with the antinomial definitions both of prolonging and of discontinuing, eventually proved so confusing that it has passed, as if weary, from common usge. So, in the scientific literature, tides in the affairs of expression lap at us continually. Positive moves in the direction of simplicity deserve our support and applause. Diminished use of eponyms in favor of descriptive terms furnishes a good example: ANUG replaces Vincent's infection (perhaps not euphoniously but certainly meaningfully) and the conviction that it does us little good to be confronted by two von Recklinghausen's diseases has pushed medical writers to use a more accurate term for each. Unfortunately, changes in terminology do not always head toward greater or more concise communication. Parameter, once left to those who knew it best as a variable or arbitrary constant in a mathematical expression, has had its lexical arm twisted. Its now popular definition as characteristic or limit may be seen in current dictionaries, though labeled as informal. Such attempts to impose a new meaning on a more complicated term when a simpler and correct word is already in use is a process perhaps worthy of consideration, especially when it strikes home. Reviewing some standard texts in endodontics, we may note a curious shift of expression in the past decade or so which may mark a trend. Sommer et al. in the third edition of Clinical Endodontics (1966) wrote

Necrotizing Ulcerative Gingivitis in the Military From Ancient to Modern Times

Necrotizing Ulcerative Gingivitis in the Military From Ancient to Modern Times

Necrotizing ulcerative gingivitis in beagle dogs. III. Distribution of spirochetes in interdental gingival tissue.

A new modification of the Warthin spirochete staining method was developed to study at the light microscopic level the distribution of spirochetes in gingival tissues of beagle dogs with induced necrotizing ulcerative gingivitis. Spirochetes were present in cellular exudate at ulcerated sites, in edematous epithelium in the vicinity of ulcerations, and in intact sulcular epithelium. They did not appear to penetrate connective tissues via the ulcerations. These observations suggest that, in the etiology of NUG, spirochetes play a role in the initiation of the pathologic process by penetration of the intercellular spaces in the epithelium.

Pericoronitis: A reappraisal of its clinical and microbiologic aspects

Pericoronitis is an infectious disease of the operculum overlying an erupting or semi-impacted tooth. It manifests itself mainly in late adolescence and young adulthood and nearly always occurs around the lower third molar. The distinctive location, age, clinical picture, and link with predisposing factors warranted a reappraisal of pericoronitis and its etiology. Spirochetes and fusobacteria proved prevalent at all stages of the disease. The presence of these microbacteria may provide a clue as to the late appearance, particular location, and singular clinical picture of pericoronitis. The fact that spirochetes and fusobacteria are also found in acute necrotizing ulcerative gingivitis, and have been associated with alveolar osteitis, indicates a possible relationship between these disorders and pericoronitis.

Infectious oral necrosis (cancrum oris) in Nigerian children: a review.

The devastating orofacial gangrenous disease known as cancrum oris (noma) is still commonly seen in underprivileged Nigerian children. These children are usually victims of such stressors as chronic malnutrition, numerous endemic communicable diseases and severe adverse physical conditions which may lead to depletion of their adaptive resources or produce physiological maladaptation to additional stressors. Measles is the most common infection preceding the development of noma in Nigerian children. Acquired immunodeficiency as well as the impaired endocrine balance of the chronically malnourished permits, for example, widespread infection with the measles virus. Anergy resulting from the combination of malnutrition and measles virus infection promotes selective overgrowth and invasion by an infective consortium consisting of anaerobic organisms and other species capable of elaborating necessary growth factors for the former. Because of the pre-existing depletion of adaptive physiologic resources in the malnourished child, the infection is not readily contained locally as necrotizing ulcerative gingivitis but instead spreads rapidly to the next naturally occurring anatomical barriers. This is then followed by continuing necrosis and possible sequestration as exemplified by noma.

Ulcerative stomatitis, gingivitis, and skin lesions: An unusual case of primary herpes simplex infection

A 2-year-old white girl had acute oral ulceration, gingivitis, pyrexia, cervical lymph node enlargement, and a generalized, initially macular and later purpuric rash. None of the common oral viral infections, with the exception of chickenpox, is usually associated with a rash. This presented a diagnostic dilemma that appears not previously to have been reported in the dental literature.

輸血後肝炎患者にみられた急性壊死性かいよう性歯肉炎の１例

Acute necrotizing ulcerative gingivitis (ANUG), also known as noma or gangrenous stomatitis, is a markedly progressive and destructive disease of the oral and facial tissues that generally occurs in debilitated individuals. However with the advent of antibiotics and the development of public health the incidence has gone down but ANUG has yet been seen with special reference to systemic diseases.We recently experienced a case of ANUG in a transfusion-associated hepatitis patient and described it in this paper.

Acute necrotizing ulcerative gingivitis in a case of systemic lupus erythematosus

Presented is an unusually severe case of acute necrotizing ulcerative gingivitis (ANUG) in association with systemic lupus erythematosus (SLE), in which the patient was observed to slough a considerable amount of attached gingival tissues and eventually to lose a number of teeth and supporting bone. The usual limited and treatable nature of ANUG is reviewed, and attention is directed to the mechanisms by which SLE and therapeutic amounts of steroids can contribute to the increased severity of the oral disease.

Demographic and clinical data associated with acute necrotizing ulcerative gingivitis in a dental school population (ANUG-demographic and clinical data).

This study was undertaken to determine the prevalence of demographic and clinical factors of patients diagnosed as having ANUG as determined by the presence of painful, bleeding, necrotic and ulcerated interproximal gingival papillae. Results showed that ANUG patients were evenly divided between males and females relative to the general clinic population. 58% of the patients with ANUG were under 25 years of age as compared to 31% under 25 in the general clinic population. Overall, the ANUG group accounted for 1.4% of the under 34 age group in the general clinic population. 76% of the ANUG group had a high school education or less with 67% having less than $5,000 annual income. Only 20% presented with elevated temperature. Only 6% of the patients with ANUG were non-smokers as compared to 63% in a matched control group. Of great significance was the fact that only 1 patient with ANUG was black as compared to a 41% black population in the clinic population.