Necrotizing Ulcerative Gingivitis



  • 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 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 (noma)


  • 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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