Necrotizing gingivostomatitis: NUG to NOMA
Necrotizing gingivostomatitis (NG) encompasses a spectrum of clinical diseases ranging from necrotizing ulcerative gingivitis (NUG) to the fatal NOMA.
The NUG lesion involves painful and bleeding ulceration of the tip of the interdental papillae in most cases. It also may have necrosis that is more extensive, however, spreading along adjacent gingiva and at times migrating to nearby areas of mucosa. When alveolar bone is exposed as a result of the necrosis, the infection maybe termed NOMA, especially when the necrosis extends through the mucosa to the skin of the face. The prevalence of NG in indus-trial countries is less than .5%; in India, Colombia, and Nigeria, however, larger numbers have been reported.
The three primary diagnostic signs of NUG are pain, interdental ulceration, and gingival bleeding. Other signs are fetid breath and pseudomembranous formation. Most cases of NG are found in the early stage and are termed NUG. The different types of NG have the same disease processes clinically and bacteriologically except for underlying systemic factors and anatomic extension of necrosis. The etiology of NG is still poorly understood. It appears to be an oppor-tunistic bacterial infection occurring in individuals predisposed by a reduced systemic resistance. A rela-tively constant set of anaerobic bacteria has been observed in NUG. Significantly reduced lymphocyte blastogenic responsiveness, neutrophil chemotaxis, and neutrophil phagocytosis have been found in NUG. There is also found a significantly elevated 17-hydroxycorticosteroid in the urine of patients with active NUG. Three patterns are observed for NG that may be helpful in revealing predisposing factors: (1) HIV-infected adult case, (2) young child case espe-cially associated with malnutrition, and (3) young adult/stress case pattern.
Treatment for NG should begin promptly. The first phase is resolution of predisposing factors, bacterial control, and supportive therapy. It is prudent to test patients with NG for HIV infection. The young adult stress patient should be counseled to begin a health-ier lifestyle. Bacterial control consists of improved home care, antiseptic rinses (chlorhexidine gluconate, povidone iodine, or Listerine), professional prophylaxis, and antibiotic use in selected cases. Metronidazole or penicillin have been the two top antibiotic choices. Supportive therapy consists of rest, fluids, and a nutritious soft diet.
Residual defects such as gingival cratering recession, and reverse architecture should be evaluated weeks after healing. Since NG patients typically fall into the noncompliant category, surgical intervention should be done cautiously. [C.S.]
Horning G.M., Compendium, 17:951,1996