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Necrotizing Ulcerative Gingivitis

Necrotizing Ulcerative Gingivitis is a topic covered in the 5-Minute Emergency Consult.

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  • Periodontal disease
  • Characterized by the “punched-out” appearance of the gingival papillae
  • Synonym(s):
    • Acute necrotizing ulcerative gingivitis
    • Trench mouth
    • Vincent disease
    • Fusospirochetal gingivitis
  • Not contagious
  • Occurs most often in children and young adults in developing nations
  • Mainly occurs in sub-Saharan Africa
  • Rare; seen mostly in severely immunocompromised patients
  • Males > females
  • Can progress to more advanced disease:
    • Necrotizing stomatitis:
      • Similar to necrotizing ulcerative gingivitis with extension to the tongue and buccal mucosa
    • Necrotizing ulcerative periodontitis:
      • Similar to necrotizing ulcerative gingivitis with periodontal attachment loss and alveolar bone involvement
    • Orofacial gangrene


  • Caused by an overgrowth of oral flora
  • Prevotella intermedia
  • Spirochetes
  • Predisposing factors (not required for diagnosis):
    • Poor oral hygiene/gingivitis
    • Immunodeficiencies (e.g., HIV)
    • Immunosuppression
    • Malnutrition
    • Smoking
    • Emotional and physical stress
    • Possible association with direct contact to certain chemicals (e.g., MDMA or ecstasy)

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Rosen, Peter, et al., editors. "Necrotizing Ulcerative Gingivitis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307310/all/Necrotizing_Ulcerative_Gingivitis.
Necrotizing Ulcerative Gingivitis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307310/all/Necrotizing_Ulcerative_Gingivitis. Accessed April 24, 2019.
Necrotizing Ulcerative Gingivitis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307310/all/Necrotizing_Ulcerative_Gingivitis
Necrotizing Ulcerative Gingivitis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307310/all/Necrotizing_Ulcerative_Gingivitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Necrotizing Ulcerative Gingivitis ID - 307310 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307310/all/Necrotizing_Ulcerative_Gingivitis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -