Necrotizing Ulcerative Gingivitis Research Articles

Diagnosing an Acute Leukemia From a Necrotizing Ulcerative Gingivitis in The Oral Cavity: a Case Report

Background: Necrotizing ulcerative gingivitis (NUG) is an acute onset of gingival disease, that presents as an acute, painful, and destructive ulceration and inflammation of gingival tissue. This condition is one of the oral manifestations of leukemia in addition to gingival enlargement and spontaneous bleeding, oral ulceration, petechiae, hematoma, and pale mucosa. Case Report: We reported A 50-year-old woman presented with gum swelling, pain, and easy bleeding in the lower jaw gums. The patient often experiences fatigue, spontaneous bruising, dry skin, and hair loss. Extraoral examination revealed bruises on the hand. Intraoral examination revealed swelling, erythematous and ulcerative lesion, tartar, bleeding on probing in the lingual gingiva of lower central incisor teeth, mucosa pallor, and minor petechiae were observed at the buccal mucosa region 47-48. The provisional diagnosis was NUG with suspicion of systemic disorder. Result: A complete blood count was performed which showed anemia, leukopenia, neutropenia, lymphocytosis, and thrombocytopenia. We diagnosed NUG in acute leukemia patients. Conclusion: This case demonstrates the detection of leukemia and its oral manifestations in acute leukemia patient. The patient was referred to the hematologist oncology.

NECROTIZING ULCERATIVE GINGIVITIS AS A COMPLICATION OF FEBRILE NEUTROPENIA IN ACUTE MYELOID LEUKEMIA PATIENT

Background: Necrotizing ulcerative gingivitis (NUG) is a periodontal disease characterized by gingival pain, interdental gingival necrosis, and bleeding. NUG is closely related to immunosuppression, smoking, poor oral hygiene, malnutrition, and stress. Acute myeloid leukemia (AML) is a bone marrow malignant neoplasm. Chemotherapy as the treatment for AML often causes febrile neutropenia which results in immunosuppression conditions and is a risk factor for NUG. This case report aimed to discuss NUG as a complication of febrile neutropenia. Case: A 22-year-old woman was referred from hemato-oncology with acute myelomonocytic leukemia (AML-M4) and febrile neutropenia due to her oral complaints. She had undergone one cycle of chemotherapy and developed febrile neutropenia. Intra-oral showed ulcers covered with white-grayish plaques on the gingival region 35 to 45 and 15 to 25. There were white plaques that could be removed leaving an erythematous area on the dorsal tongue. Blood laboratory tests showed pancytopenia and severe neutropenia. The diagnoses were necrotizing ulcerative gingivitis and pseudomembranous candidiasis. Case management: Debridement using 1.5% hydrogen peroxide solution, rinsing with 0.2% chlorhexidine gluconate, as well as cleaning teeth and tongue 2 times daily. The internal medicine department gave meropenem. The lesions and gingiva were healed after three weeks of therapy. Conclusion: Febrile neutropenia due to chemotherapy reduces the body's ability to fight infection, oral homeostasis is disturbed therefore bacterial growth increases, neutrophils carry out phagocytosis forming reactive oxygen species which causing necrotic cells and then NUG occurred. Appropriate, adequate, and immediate therapy is needed to avoid further complications. Keywords: Acute myeloid leukemia, Febrile neutropenia, Necrotizing ulcerative gingivitis

Effectiveness of photodynamic therapy adjunct to oral debridement in improving clinical, microbiological, and pain in necrotizing ulcerative gingivitis.

To evaluate the efficacy of photodynamic therapy (PDT) as adjunctive to oral debridement (OD) in the improvement of clinical, microbiological, and pain in patients with necrotizing ulcerative gingivitis (NUG). Patients with NUG were split into two groups: Group-OD + PDT received PDT with OD, while Group-OD underwent OD alone. Clinical inflammatory parameters including full mouth plaque scores (FMPS), full mouth bleeding scores (FMBS), and probing depth (PD) were assessed. Fusobacterium nucleatum and Prevotella intermedia were analyzed using the polymerase chain reaction technique. Pain examination was done using various pain scales. Group PDT + OD showed more reduction in FMPS, FMBS, and greater reduction in F. nucleatum and P. intermedia count compared to group OD at 12 weeks follow up (p < 0.01). Group PDT + OD showed significantly lower pain scores at 12 weeks (p < 0.05). PDT was more effective in improving clinical parameters, and reducing bacterial counts and pain in NUG patients than dental scaling alone.

Microbial Corrosion in Orthodontics

Even with the exponential popularity of the contemporary clear aligners, the main stream of orthodontic practice still remains to be metal braces especially in adolescent age-group.1 Along with the advantages of metal braces such as lower cost, reduced friction, etc., there goes the disadvantages such as corrosion possibility, reduced esthetics, etc. Corrosion of orthodontic appliances is a widely researched topic.2-5 It is surprising to learn that microbially induced corrosion (MIC) has not been addressed in orthodontic literature till date. Microbial corrosion is an interesting arena which requires knowledge of both corrosion science and microbiology. The microorganisms capable of corrosion include various bacteria, fungi, and algae. The most common among them which has been widely indicated in MIC are the bacteria belonging to the sulfur cycle especially the sulfate-reducing bacteria (SRB). The connecting knot with orthodontics is the reported prevalence of these SRB in the oral cavity. SRB is prevalent in healthy individuals,6,7 patients associated with periodontitis6-11 and patients with gastrointestinal issues.12-14 The prevalence of SRB in the oral cavity has a greater clinical implication since the SRB have been proven to cause corrosion of stainless steel.15-24 There is literature attributing SRB as a potential cause in periodontal diseases7-11 as well as gastrointestinal diseases such as ulcerative colitis, inflammatory bowel diseases, and Crohn's disease.12 With its presence in the healthy oral environment already reported in the previous studies,6,7,25,26 it further emphasizes the absolute need to be researching on its corrosion possibility in the intra oral environment. The genus generally found intraorally was Desulfovibrio and Desulfobacter10 which is commonly regarded as the most "opportunistic" and ubiquitous group of sulfate reducers.6,7 There is an interesting literature on the inhibition of Desulfovibrio spp. by human saliva, the reason being quoted as salivary nitrate and nitrite.14 The mechanism behind the antimicrobial action of nitrate and nitrite is that they increase the oxidative stress on the bacteria.27 However, concentrations of salivary nitrate vary depending on the food intake, endogenous production, and salivary flow rate.28,29 Despite there exist natural inhibitors, the prevalence in oral cavity is high, 22% in healthy and 86% in patients associated with periodontitis.7 There is a predilection for the bacteria to grow when favorable conditions exist. Biofilms is one such favorable medium for the growth of SRB. Paster et al.26 identified SRB in biofilms of patients associated with refractory periodontitis, periodontitis, acute necrotizing ulcerative gingivitis (ANUG), and also in healthy subjects. Biofilm is a surface film composed of organic and inorganic saliva components that are colonized with microorganisms in extracellular polymeric substances adsorbed on all surfaces in the oral cavity.30 The oral biofilm formation is a complex process involving interspecies aggregation, which is surrounded by a cohesive matrix, forms a complex structure which in turn facilitates anaerobic growth. It is the intrinsic nature of oral biofilms which make the survival of facultative anaerobes such as SRB in the oral cavity possible. Literatures31-35 report that there are increased biofilm formations in orthodontic patients due to increased retentive areas caused by the brackets, ligatures, wires, mini implants, force components, and archwires. Bacteria in dental plaque function as a metabolically, functionally, and physically integrated community.36 The study by Mystkowska et al.37 mentioned that biofilm per se play a critical role in corrosion process by forming corrosive microcells. With time-dependent association, the microbes in the biofilm, along with saliva acting as an electrolyte and components from food, causes a decreased pH in the areas immediately under the biofilms. The decreased pH along with a change of oxygenation releases metal oxides and hydroxides from the metal surface ultimately leading to the corrosion of metallic structures.37-41 The initial roughness also acts in a vicious form promoting more biofilm adherence and the process repeats causing more corrosion. With the biofilm itself serving to initiate and propagate corrosion, the increased prevalence of SRB in patients associated with orthodontics treatment all the more increases the possibility of MIC of orthodontic materials.

NECROTIZING ULCERATIVE GINGIVITIS LEADING TO SEPSIS IN ONCOLOGICAL PATIENT: A CASE REPORT FOCUSED ON ORAL DIAGNOSIS

Synovial sarcoma is a malignant soft tissue tumor occurring mostly in young adults that is treated with surgery, chemotherapy, and/or radiotherapy. The objective is to report a case of necrotizing ulcerative gingivitis (NUG) as a focus of sepsis in a patient with synovial sarcoma undergoing chemotherapy. A 26-year-old male patient with synovial sarcoma was admitted to the emergency room reporting gingival pain and swelling. Clinical examination showed erythematous and purplish lesions in the gingiva, necrotic tissue and pseudomembranes in the papillae, and purulent exudate, resulting in a diagnosis of NUG. It was necessary to transfer the patient to intensive care unit due to sepsis from the dental focus and febrile neutropenia. Treatment involved antibiotic therapy, improvement of oral hygiene, and photobiomodulation with a low-level laser. We highlight the importance of hospital dentistry in the multidisciplinary team for individual patient care leading to a specific dental diagnosis and prompt treatment. Synovial sarcoma is a malignant soft tissue tumor occurring mostly in young adults that is treated with surgery, chemotherapy, and/or radiotherapy. The objective is to report a case of necrotizing ulcerative gingivitis (NUG) as a focus of sepsis in a patient with synovial sarcoma undergoing chemotherapy. A 26-year-old male patient with synovial sarcoma was admitted to the emergency room reporting gingival pain and swelling. Clinical examination showed erythematous and purplish lesions in the gingiva, necrotic tissue and pseudomembranes in the papillae, and purulent exudate, resulting in a diagnosis of NUG. It was necessary to transfer the patient to intensive care unit due to sepsis from the dental focus and febrile neutropenia. Treatment involved antibiotic therapy, improvement of oral hygiene, and photobiomodulation with a low-level laser. We highlight the importance of hospital dentistry in the multidisciplinary team for individual patient care leading to a specific dental diagnosis and prompt treatment.

Prevalence of Oral Lesions among HIV Positive Patients Attending Antiretroviral Therapy Centre in Rural Area of Western Maharashtra

Introduction: The Oral Manifestations (OM) of Human Immunodeficiency Virus (HIV) is indication of compromised immune status and disease progression. These Oral Lesions (OL) cause morbidity and affect quality of life of the patients. Aim: To evaluate the association between OM in patients with HIV infection and their level of cluster of differentiation 4 (CD4) count. Materials and Methods: The study was designed as a descriptive, cross-sectional study for a duration of two years which included a total of 565 known HIV-positive individuals visiting the regional Antiretroviral Therapy (ART) center for counseling and/or on Highly Active Antiretroviral Therapy (HAART) were selected irrespective of age and sex. The oral lesions were diagnosed using the presumptive criteria given by by the European Committee (EC) Clearinghouse, 1993. Oral and systemic manifestations were recorded and associated with CD4 counts. The data collected was subjected to statistical analysis using Statistical Package of Social Science (SPSS) 8.0 software and p-value was considered significant at a level of 0.05. Results: The male-to-female ratio was almost equal and 95.04% of the patients had reported heterosexual contact as the transmission route. The peak age of occurrence of HIV infection was during 31-40 years with the mean age of males and females 39.26 years and 34.46 years respectively. Pulmonary tuberculosis (16.11%) and herpes zoster (16.81%) were the most common systemic manifestations. The prevalence of OM reported was 86.01% and was higher in females than in males. Intraoral melanotic pigmentation (50.08%) was the most common finding, followed by periodontitis (36.46%), linear gingival erythema (14.51%), Necrotising ulcerative gingivitis (NUG) (4.42%), candidiasis (8.67%), oral ulcers, herpes zoster (5.13%), herpes simplex virus infection (1.17%) and salivary gland disease (SGD) (0.7%). There was a significant association (p=0.0110) between OL and reduced CD4 count. Conclusion: OL occur commonly in HIV infection. The decrease in CD4 count is associated with a wide range of OM. The result from this study can be used as predictive marker for oral manifestations in AIDS based on the level of immune suppression and help in improving their quality of life.

Prevalence of Oral Lesions and Its Associated Risk Factors Among PLHIV Availing Anti-Retroviral Therapy from a Selected Tertiary Care Hospital, Puducherry - A Cross Sectional Analytical Study.

Background and Objectives:Oral lesions are among the earliest and most important indicators of infection with human immunodeficiency virus (HIV). The presence of oral lesions has a significant impact on the physical and mental health of the PLHIV. Hence, a novel attempt is made to assess the prevalence of various types of oral lesions among the adult people living with human immunodeficiency virus (PLHIV) undergoing antiretroviral therapy.Methodology:In this facility-based cross-sectional study, a total of 239 out of 300 eligible PLHIV were assessed between September and October 2018. All consecutive eligible patients encountered during the data collection period were included. Oral examination was carried out using disposable mouth mirrors, sterile piece of cotton, and bright illuminated torch.Results:The prevalence of oral mucosal abnormalities was found to be 25% (95% confidence interval: 20.03–30.97). The most prevalent oral lesions were acute necrotizing ulcerative gingivitis, acute necrotizing ulcerative periodontitis, and candidiasis. CD4 count <200 cells/mm3, current tobacco use, and alcohol usage were significantly associated with the prevalence of oral lesions.Conclusion and Recommendations:The study revealed that one-fourth of the study participants had oral lesions. Strategies for early detection and prompt treatment of oral lesions need to be planned and incorporated in the program to reduce the morbidity due to oral lesions.

THE METHOD OF TREATMENT OF PRIMARY ULCERATIVE GINGIVITIS

Despite the relatively low prevalence, necrotizing ulcerative gingivitis is the most severe among gingivitis, associated with microflora of dental biofilm and very rapid tissue destruction. The study involved 12 patients, aged 22-27 years, with acute necrotizing ulcerative gingivitis (ANUG). The new treatment approach, that was developed and tested by the authors, was used in the therapy of all ANUG patients. The treatment was considered effective in achieving positive results in the clinical picture of the disease and laboratory tests. On day 3 of gingivitis treatment, all patients subjectively noted a significant improvement in general condition, alleviation of pain. On day 7 following the treatment, subjectively, all patients had no complaints, and, objectively, the absence of edema and redness in the affected areas of the gums was noted in 9 (75%) patients; in 3 (25%) patients, a slight redness of the gums of the marginal area was detected, as well as the presence of non-mineralized dental plaque. The proposed method of treatment with the use of Tantum Verde spray as part of the complex therapy is effective, easy to use and can be recommended for use in dentistry as the anti-inflammatory therapy of primary ulcerative gingivitis. Perspectives of further research will encompass the follow up search for the effective methods of comprehensive treatment of patients with uncreative gingivitis.

From trench mouth to noma: Experiences from Nazi extermination camps

Trench mouth, as it occurred especially in World War I in soldiers, is a necrotizing ulcerative gingivitis (NUG) in people who have poor oral hygiene, malnutrition, vitamin deficiency, a smoking history, and psychic stress. When not treated properly, this condition can lead to noma. NUG and noma are mainly seen today in severely malnourished, poorly cared for, and immunocompromised children in extremely poor living conditions, mainly in sub-Saharan Africa. In 20th century history, the occurrence of noma in Turkey was described by Albert Eckstein (1891-1959), but noma is particularly linked to the atrocious living conditions in the Nazi exterminations camps, such as Auschwitz, where large numbers of patients with noma were treated in Berthold Epstein's (1890-1962) Noma Department in the Zigeunerlager (Gypsy Camp) under the supervision of SS physician Josef Mengele (1911-1979). Although these patients were treated successfully, all of them, mostly children, were ultimately killed. The protocols of the noma research are lost, and descriptions from Auschwitz are scarce. Fortuitously, there are some testimonies, especially from postwar trials, that give insight on this ambiguous and repressed topic.

Assessment of oral health status and treatment needs of drug abusers in Bhubaneswar city: A cross-sectional study.

Introduction:Oral health of drug abusers has received less attention. Drug users may also have special needs in relation to receiving dental care. Evaluation of the oral health status of drug abusers is important as in India, where the disease burden is enormous, and availability of curative treatment is quite inadequate, preventive approach shall prove to be better than curative treatment.Aim:To determine the oral health status and treatment needs of drug abusers residing in rehabilitation centers in Bhubaneswar.Materials and Methods:A cross-sectional study was conducted in the drug de-addiction cum rehabilitation centers in Bhubaneswar city, Odisha. A self-administered questionnaire was used to record oral health practices of the inmates and the type of drugs used by them in the past. Oral health was recorded using modified WHO 2013 pro forma. Mann–Whitney U-test and Kruskal–Wallis test were applied to find any significant differences between different variables in groups.Results:All the participants were male and alcohol was the most commonly used drug, followed by tobacco and ganja. The horizontal brushing technique was the most widely used technique. Mean decayed, missing, and filled teeth (DMFT) score was recorded to be 1.48. Leukoplakia, acute necrotizing ulcerative gingivitis, candidiasis, and ulceration were among the few oral lesions found in the inmates. Around 67.66% of inmates exhibited erosion of the enamel surface, while 6.59% had signs of enamel fracture. Statistically, significant difference was found for the types of drugs used and DMFT score and type of drug used and dental erosion.Conclusion:Oral health status of drug users is poor and needs immediate attention. Oral health education needs to be imparted among them. The government needs to enforce the establishment of dental clinics in these centers so that the oral health of these people can be taken care of.

Oral manifestations of HIV: Can they be an indicator of disease severity? (A systematic review).

To review the existing research literature on the paradigm that the oral lesions could be an indicator of the disease severity with the objective of documenting the current status of research, highlighting its major findings. Publications were identified through a careful search, of which a majority focused on oral lesions as an indicator for HIV progression. A PubMed journal search of 10years OF period publication (2009-2019) for "oral lesion, oral manifestation, indicator, HIV and HIV-associated" was performed and analysed. Various research methods were included within the study criteria including clinical study, clinical trial, comparative study and randomised control trial. A total 33 studies were obtained and analysed, including cohort study, cross-sectional study, case-control study, clinical trial, retrospective observational analysis study, prospective observational study and randomised control trial. The most common oral lesions found in the studies were Kaposi sarcoma (KS), followed by oral candidiasis, periodontitis, necrotising ulcerative gingivitis (NUG), necrotising ulcerative periodontitis (NUP) and oral hairy leucoplakia (OHL). The early diagnosis and accurate treatment plan were very important to indicate the disease severity related to HIV infection. Oral lesions reported in 39% articles and could be an indicator of HIV disease severity due to its effects on decreased cluster-differentiated (CD4+) T-cell count and increased viral load.

Bactericidal and clinical efficacy of photochemotherapy in acute necrotizing ulcerative gingivitis.

This study was designed to investigate the clinical and microbiological parameters with photochemotherapy (PCT) against conventional debridement (CD) among patients with necrotizing ulcerative gingivitis (NUG). Patients with a diagnosis of NUG were divided into two groups: 'Group-PCT' that underwent indocyanine green-mediated PCT with adjunctive mechanical debridement, and Group-CD that underwent mechanical debridement with adjunctive 3 % hydrogen peroxide/chlorhexidine rinse. Clinical inflammatory gingival parameters including full-mouth plaque scores (FMPS), bleeding scores (FMBS), and probing depth (PD) were measured. Counts of Treponema microdentium, Fusobacterium nucleatum and Prevotella intermedia were assessed using polymerase chain reaction technique. All assessments were done at baseline, 3 weeks and 6 weeks. Twenty-six participants were contacted and agreed to participate in the trial. The mean age of participants in group-PCT was 24.5 years while the mean age of patients in group-CD was 26.7 years. FMPS showed significant but equal reduction in both the groups at 3 weeks and 6 weeks (p < 0.01). The reduction in mean FMBS was higher in the group-PCT at 6 weeks follow-up (p < 0.05). All bacterial levels reduced from baseline to follow-up with both PCT and CD groups (p < 0.05). Group-PCT showed significantly reduced counts of T. microdentium and F. nucleatum at 3 weeks and 6 weeks compared with group-CD (p = 0.024). Equal reduction was shown for P. intermedia between both the groups at 3 and 6 weeks, respectively. Application of adjunctive photochemotherapy was both clinically and microbiologically effective in the treatment of NUG.

A novel treatment of necrotizing ulcerative gingivitis using ozone therapy

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.

The correlation of pathognomonic periodontal manifestation with CD4+ level in people live with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in a Tertiary Hospital, Surabaya, Indonesia

Aim: The prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients worldwide continue increasing annually, thus it has become a global health problem and burden. An oral manifestation can be used as the clinical biomarkers in people living with HIV/AIDS (PLWHA) using the pathognomonic periodontal manifestation, such as Necrotizing Ulcerative Gingivitis (NUG) and Necrotizing Ulcerative Periodontitis (NUP). This study aims to investigate the prevalence and correlation of pathognomonic periodontal manifestations with Cluster of Differentiation 4 (CD4+) level in PLWHA in a tertiary hospital, Surabaya, Indonesia. Materials and Methods: It presents an observational analytical study with a cross-sectional and total sampling method conducted from July to August 2014 in Dr. Soetomo General Tertiary Hospital. There were 88 HIV-seropositive patients who have not received any antiretroviral therapy yet who were recruited for this study. The patients and their guardians were explained about the study aims and participation approval which was obtained by the written informed consents. The diagnosis of NUP and NUG in PLWHA was based on its clinical features. The CD4+ level the latest 6 months was obtained from medical record as a retrospective data. The correlation between low CD4+ levels with pathognomonic periodontal manifestation in PLWHA was analyzed by Spearman's correlation test. Results: There are 9 (10.23%) PLWHA with pathognomonic periodontal manifestation, 7 (77.7%) with NUG, and 2 (22.3%) with NUP. All PLWHA (100%) have low CD4+ level (<200 cell/mm3). The Spearman's correlation shows that there are a correlation between pathognomonic periodontal manifestation with CD4+ level in PLWHA (r = −0.464) (P = 0.03; P < 0.05). Conclusion: NUG and NUP are pathognomonic periodontal manifestation found in Indonesian PLWHA which are associated with low CD4+ level reflecting the immune suppression level, and it can be used to predict HIV/AIDS stage of progression.

Guidelines for Clinical Management of patients with Acute Necrotizing Ulcerative Gingivitis: A Literature Review

The aim of this article is to review the literature for existing protocols on management of patients with acute necrotizing ulcerative gingivitis (ANUG) and to propose a protocol after compilation of various relevant protocols from literature. A literature search was conducted and articles were chosen with relevance to title and/or abstract with relevance to ANUG and treatment of ANUG. A systematic management regimen for different populations of ANUG patients namely – children, adults, and immunocompromised, has been formulated. This guideline is intended to help practitioners make decisions regarding treatment of ANUG and to help update their knowledge about the disease condition.

Pemphigus Vulgaris

We present the case of a 44-year-old woman with pemphigus vulgaris (PV) of 2 months’ duration. She presented to an emergency department (ED) for evaluation of her condition where she was diagnosed with acute necrotizing ulcerative gingivitis (ANUG).

A comparison of culture and PCR methods for identification of Aggregatibacter actinomycetemcomitans isolated from acute necrotizing ulcerative gingivitis

Objective: To determine Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) isolated from periodontal patients and healthy subjects using culture and PCR methods. Methods: Duplicate paper point needles were taken from 100 samples (50 healthy subjects and 50 patients), who referred to the specialized dental clinic from Oct. 2015 to Mar. 2016. In laboratory after incubation period and observing the star-shaped colony A. actinomycetemcomitans, the confirmation tests, including gram staining and catalase test were carried out. For PCR, samples were analyzed with genus specific primers. These primers set, amplified a 500 bp fragment. Results: Of the 100 samples, A. actinomycetemcomitans was isolated from 31 patients (31%), (24 isolate of patients, and 7 isolate of healthy subjects) by using a selective Aggregatibacter isolation medium. Using PCR, a total of 49 (49%) samples were found to be positive for A. actinomycetemcomitans (35 isolate of patients, and 14 isolate of healthy subjects). Conclusion: PCR was found to be highly sensitive when genus specific primers were used for diagnosis of A. actinomycetemcomitans in comparison with culture method.

The first dentists sent to the Western Front during the First World War.

At the outbreak of the First World War there was insufficient dental provision for serving military personnel. No army dental specialists were available overseas when the troops joined the British Expeditionary Force (BEF). However, the pain of toothache together with the ensuing limited mastication was debilitating and demoralising for the British soldiers. The result was that men were being withdrawn from the front for treatment at base hospitals. This was limited to extractions by medical officers, which frequently incurred unnecessary loss of dentition when restorative work would have been preferable. Other consequences of dental neglect were indigestion and malnutrition. Additionally, the painful condition of acute necrotising ulcerative gingivitis, then commonly referred to as 'trench mouth', was prevalent.

Necrotising Ulcerative Gingivitis: A Literature Review

The literature surrounding necrotising ulcerative gingivitis (NUG) is extensive, yet the rare nature of this disease means that there is a lack of good quality research available. This paper aims to scrutinise the literature and provide an up-to-date summary of the available information. A literature search was performed electronically using the Cochrane Library, Ovid Medline, Embase, PubMed Clinical Queries and Google Scholar. Keyword searches were carried out, utilising MeSH terms and free text. English language articles primarily were included, with key foreign language (French and German) articles included where possible from the 1900s to the present day. Necrotising ulcerative gingivitis is a rare disease (prevalence <1%), with an acute, painful and destructive presentation. It is an opportunistic bacterial infection which is predominantly associated with spirochetes. Treatment of NUG must be provided on a case-by-case basis, tailored to what the individual can tolerate and the extent of the infection. Although there is low prevalence of NUG, its importance should not be underestimated as one of the most severe responses to the oral biofilm. Risk factors must be investigated and addressed. Treatment should consist of gentle superficial debridement, oral hygiene instruction and prescription of mouthwash and antibiotics in severe cases.

Prevalence and treatment of necrotizing ulcerative gingivitis (NUG) in the British Armed Forces: a case-control study.

Necrotizing ulcerative gingivitis (NUG) has been seen in military populations throughout history. This study aims to determine the prevalence, treatment modality and risk factors associated with NUG in the British Armed Forces. A whole population dataset of the British Armed Forces was searched to determine cases of NUG during the period 1 January to 31 December 2012. Individual case records were identified, and a case-control study undertaken with data gathered and analysed against a randomised control group, matched for age, sex and service. A prevalence rate for NUG of 0.11% was determined against the whole military population. The majority of cases received (alone or in combination) the following: oral hygiene instruction (66.5%), antibiotics (64.4%) and a mouthwash (58.1%). Of the cases, 48.7% received debridement. Analgesics were only prescribed in 8.4% of the cases, and smoking cessation advice was only given in 10.7% of the cases. Analysis of risk factors against the control group showed an increase in odds ratios for diagnosis of NUG of 3.4 (95% CI 2.0-5.7) for current smokers and 7.3 (95% CI 1.9-28.0) for individuals with an overall Basic Periodontal Examination (BPE) score of 3. Whilst NUG is a rare disease, it is evident from this study that it still occurs within the British Armed Forces. A strong association was shown between NUG and current smokers and those cases with an overall BPE score of 3. This study provides prevalence data for NUG in the British Armed Forces and description of its treatment and associated risk factors. Oral hygiene and smoking must be addressed in patients with NUG and prescribing protocols should be carefully followed.