Acute necrotizing ulcerative periodontal disease


Acute necrotizing ulcerative periodontitis (ANUP) is a special form of periodontitis that usually arises from acute necrotizing ulcerative gingivitis (ANUG).
In acute necrotizing ulcerative periodontitis, it is not only the gums that are affected, as is the case with gingivitis, but above all the teeth supporting structures. It is a rapidly progressing inflammation that is accompanied by acute pain and in which tissue decay (necrosis) and the formation of ulcers (ulceration) occur at the beginning of the disease.


It is a mixed infection of different bacterial strains, including Fusobacteria strains, Treponema and Selenomonas strains, as well as the bacterium Prevotella intermedia and Porphyromonas gingivalis.
Necrotizing ulcerative periodontitis arises from necrotizing ulcerative gingivitis and its causes include psychological stress, a weakened and poorly functioning immune system, for example in HIV-positive patients, malnutrition, poor oral hygiene and tobacco consumption. Infection usually occurs in adolescence or in young adults, but late infection in elderly patients cannot be ruled out.

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Due to the acute pain and the rapid course of the inflammation, a dentist should be consulted at the first signs.
During the first inspection of the oral cavity, the doctor can recognize and treat typical symptoms of necrotizing ulcerative periodontitis. A laboratory test can also provide information about the bacterial strains and, if necessary, enable targeted treatment.

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These symptoms could indicate acute necrotizing ulcerative periodontitis

In necrotizing ulcerative periodontitis, the inflammation spreads to all structures of the tooth supporting apparatus. Necrosis of the gums and bones occurs. At the beginning there is severe necrosis of the gingival papillae up to interdental craters and exposed bone. This is accompanied by bleeding and severe pain. The initial pain is a key differentiator from other periodontal diseases, as these are usually painless.

The poor oral hygiene results in greyish-yellow deposits on the oral mucosa. This leads to the formation of sores (ulceration). Usually it comes to a putrid or metallic taste in the mouth and bad breath. General medical practice can lead to fever and inflamed lymph nodes. Overall, the general state of health is poor. The symptoms do not all have to be present and depend on the extent and severity of the disease. The pain makes it very difficult to take in food and oral hygiene is not good, which worsens the general condition and further promotes the inflammation in the mouth.

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Therapy for necrotizing ulcerative periodontitis consists of two parts. Acute therapy includes the elimination of germs in order to prevent the inflammation from spreading further and thus to curb disease activity. First, the pain should be reduced so that adequate oral hygiene is possible again. The dentist will remove the plaque under local anesthesia and then use disinfecting rinses (e.g. CHX®). The plaque is removed thoroughly either with hand instruments such as curettes or with ultrasonic instruments.

An additional local use of a corticosteroid preparation (e.g. Dontisolon®) also helps to prevent the release of tissue-dissolving messenger substances and enzymes. As a second therapy point, additional therapy with antibiotics (e.g. penicillin) can be useful, especially if the general condition does not improve after the previous acute therapy and the symptoms do not decrease significantly after 2-3 days. Thorough oral hygiene by the patient at home and regular disinfecting mouth rinses (e.g. CHX®) are very important for a successful healing process.

If the pain is very severe at the beginning of therapy, a pain reliever (e.g. Ibuprofen®) can help. Since necrotizing ulcerative periodontitis indicates a weakened, poorly functioning immune system and is one of the early symptoms of some diseases, such as HIV infection, you should also be examined by an internist. The acute therapy is followed by maintenance therapy, which includes regular check-ups and thorough teeth cleaning.

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Once the acute necrotizing ulcerative periodontitis is overcome, it is important to continue to exercise careful oral hygiene to prevent the inflammation from recurring.
Close checks by the dentist are also important. By eliminating the causal factors, complete healing can take place. The duration of treatment depends on the extent and severity of the inflammation and varies from patient to patient. Usually, however, an improvement occurs quickly after the first removal of the germs.

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