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PubMed1988

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)

Female↗
PubMed2004

The epidemiology, etiology, and pathophysiology of acute necrotizing ulcerative gingivitis associated with malnutrition.

Acute Necrotizing Ulcerative Gingitivitis (ANUG) is a distinct and specific disease. This disease entity has been described as far back as the days of Hippocrates and is known by many synonyms. With the advent of antibiotics and with improved nutritional status, the incidence has decreased and even become extinct in developed countries. However, with the increasing incidence of severe immunodeficiency states such as seen in Acquired Immunodeficiency Syndrome (AIDS) the lesion has once more, become a well recognized and often encountered clinical entity in developed countries. In developing countries, however, the condition is still a commonly diagnosed clinical lesion because of the persistently poor nutritional status. Because of the current campaign for increased focus on global health issues, ANUG, a lesion of significant interest for the developing countries where malnutrition is high and for developing countries because of the AIDS, a global pandemic has resurfaced as a topic for discussions and study. This literature review will provide a better understanding of the epidemiology, etiology, and pathophysiology of ANUG associated with malnutrition.

Africa South of the Sahara↗
PubMed1993

Serum IgG and IgM levels to bacterial antigens in necrotizing ulcerative gingivitis.

Previous studies of the systemic antibody response in necrotizing ulcerative gingivitis (NUG) have elicited varying results. The purpose of this study was to determine the humoral response to site-specific isolates of microbiota associated with NUG. Sera from 21 active NUG subjects and 21 age-sex-race matched controls were assessed for IgG and IgM antibodies to 4 clinical isolates of Prevotella intermedia and 3 clinical isolates of Treponema species. P. intermedia and Treponema strains were isolated from active and inactive sites of NUG patients and gingivitis sites of controls. P. intermedia was also isolated from noninflamed sites of the controls. IgG and IgM serum levels to these 7 bacteria were measured by ELISA. Compared to control subjects, the NUG sera exhibited significantly lower IgG and IgM levels to all 4 isolates of P. intermedia (P < or = 0.001). It was also noted that sera from NUG subjects had elevated IgM levels to all 3 spirochete isolates but significantly higher only to the spirochete isolated from a gingivitis site of a control subject (P < or = 0.005). The data suggest that failure to mount a substantial antibody response to P. intermedia may be associated with onset of disease activity in NUG. However, the assumed lack of "biological significance" between differences in antibody responses measured indicates the relationship is weak or nonexistent. It also appears that antibody response to spirochetes is not associated with onset of NUG.

Adolescent↗
PubMed2000

[The prevalence of acute necrotizing ulcerative gingivitis in Swiss military collectives].

A group of 1595 military trainees (age range 18 to 30) were screened for the appearance of acute necrotizing ulcerative gingivitis. In a second phase four military dentists examined over 2800 newly entered trainees. Criteria for the diagnosis of ANUG were (1) Ulceration and necrosis of the interdental papilla, (2) bleeding and (3) pain. Among the 1595 recruits no ANUG could be detected, and no case of ANUG was reported by the four military-dentists. Thus, the prevalence of acute necrotizing ulcerative gingivitis was calculated to be below 0.03%.

Acute Disease↗
PubMed1991

The treatment of acute necrotizing ulcerative gingivitis.

The destruction of the interdental papillae and formation of permanent gingival craters are common sequelae of acute necrotizing ulcerative gingivitis. These craters can be disfiguring, especially in the anterior gingiva, and can act as a nidus for recurrent episodes. Traditional therapy has emphasized a surgical approach for elimination of these defects, often increasing the esthetic problems. The purpose of this paper is to review the treatment modalities of acute necrotizing ulcerative gingivitis and illustrate an alternative treatment approach of periodic scaling, root planing, and antimicrobial rinses with 0.12% chlorhexidine. With this therapeutic regimen, the disease process can be reversed and damaged papillae may regenerate.

Chlorhexidine↗