ACUTE GINGIVAL LESIONS

KARTHIK MK,
ASSOCIATE PROFESSOR,
DEPARTMENT OF PERIODONTOLOGY,
TEERTHANKER MAHAVEER DENTAL COLLEGE
PERIODONTOLOGY

Peri: around
Odontics = teeth

Periodontology can be defined as the science that

deals with the structures that support and surround
the tooth.
The periodontium comprises the following tissues:
(1) the gingiva (G),
(2) the periodontal ligament (PL),
(3) the root cementum (RC), and
(4) the alveolar bone (AP).
GINGIVA
the part of the oral mucosa that covers the alveolar
processes of the jaws and surrounds the necks of the
teeth.
Gingivitis
Inflammation limited to the gingiva.
Gingiva is inflamed,
1. Reddish,
2. Enlarged,
3. Loss of stippling, Healthy gingiva
4. Soft and edematous,
5. Bleeding on probing,

gingivitis
Periodontitis

Inflammation extends beyond the gingiva resulting in

1. alveolar bone destruction

2. loss of attachment
ACUTE GINGIVAL LESIONS
Acute Necrotising Ulcerative Gingivitis

destructive disease of the gingiva.

single tooth or group of teeth.

Epidemiology and Prevalence

epidemic pattern.
highest incidence: 15-30 years .
Oral Signs
punched out, craterlike depressions interdental
gray, pseudomembranous slough.
gingival margn is red, shiny, and hemorrhagic.
Spontaneous gingival bleeding
fetid odor
increased salivation.
Oral Symptoms
extremely sensitive
constant radiating, gnawing pain that is
intensified by eating spicy or hot foods and
chewing.
metallic foul taste
"pasty" saliva.
Extraoral and Systemic Signs and Symptoms
Local lymphadenopathy
slight elevation in temperature
Etiology

fusiform bacillus
spirochetal organism (Plaut and Vincent).
Predisposing Factors-Local
Preexisting gingivitis,
injury to the gingiva,
Smoking

Predisposing Factors systemic

nutritional deficiency.
debilitating diseases.
psychosoamtic factors.
Treatment
1. alleviation of the acute inflammation plus
treatment of chronic disease
2. alleviation of generalized toxic symptoms such as
fever and malaise, and
3. correction of systemic conditions that contribute
to the initiation or progress of the gingival
changes.
Herpetic Gingivostomatitis

Herpes simplex virus type 1.

Children < 6 years of age.

Etiopathogenesis
virus ascends through sensory and autonomic nerves
persists in neuronal ganglia - latent HSV
majority of childhood infections are subclinical.
Transmission - droplet infection
Incubation period 1 week
diffuse, erythematous, shiny involvement of the
gingiva and the adjacent oral mucosa.
varying degrees of edema and gingival bleeding.
discrete, spherical gray vesicles.
painful, small ulcers
red, elevated, halolike margin and a depressed,
yellowish- or grayish-white central portion.
Course : 7 to 10 days.
Oral Symptoms
generalized "soreness" of the oral cavity difficulty
in eating and drinking.
pain and sensitivity to touch, thermal changes,
foods such as condiments and coarse foods.
Infants - irritability and refusal to take food.
Extraoral Signs & Symptoms
Febrile illness with a raised temperature of 100-
102 F (37.8-38.9 C).
Headaches, malaise, oral pain, mild dysphagia,
and cervical lymphadenopathy.
Recurrent Herpes
Reactivation of the latent virus/reinfection
sunlight, trauma, fever, or stress

Herpes genitalis
Herpes labialis
Ocular herpes

Herpetic whitlow
Treatment

Topical/systemic acyclovir.
topical local anesthetic - lidocaine hydrochloride.
NSAIDs.
Local or systemic application of antibiotics
Persistent cases- referred to a physician for medical
consultation.
Herpes Zoster

Varicella Zoster virus.

Reactivation of dormant virus in the dorsal root
ganglion of trigeminal nerve.
elderly and immunocompromised individuals.
Intraoral lesions with/without skin lesions -
unilateral.
Pain, paresthesia.
Vesicles, rupture- fibrin-coated ulcers.
Coalesce irregular forms.
Treatment
Soft, liquid diet
Bed rest
Plaque removal
Mouthrinses
Anti-viral therapy
Pericoronitis

Inflammation of the gingiva in relation to the

crown of an incompletely erupted tooth.
mandibular third molar area.
acute, subacute or chronic.
 Varying degrees of ulceration along its inner surface.
interferes with complete closure of the jaws, trauma and
aggravating the inflammatory involvement.
Signs & Symptoms
markedly red, swollen, suppurating lesion
exquisitely tender
radiating pain to the ear, throat, and floor of the
mouth.
foul taste.
inability to close the jaws.
Swelling of the cheek and lymphadenitis.
fever, leukocytosis, and malaise.
Treatment
Acute pericoronitis
1. gently flushing the area with warm water to remove
debris and exudate
2. swabbing with antiseptic after elevating the flap
3. Antibiotics - severe cases.
 Chronic pericoronitis
Extraction
Operculectomy