Necrotizing Ulcerative Gingivitis (NUG)
This is a severe inflammation of the gingival
tissue. See figure 2-13. Sometimes NUG is called
by the more common nametrench mouth. It may
result from untreated marginal gingivitis. Other
factors that contribute to NUG include poor oral
hygiene and dietary habits, excessive smoking or
alcohol consumption, and poor physical condition
of the patient. NUG is not contagious.
SYMPTOMSThe symptoms are the same as
those of marginal gingivitis. In addition, the
patient may complain of a bad taste and pain
when eating or brushing.
SIGNSThe signs are similar to those for
marginal gingivitis, but they will probably be more
severe. For example, there may be more bleeding,
and the patient may feel more pain when finger
pressure is applied to the affected area. Also,
calculous and plaque deposits may be greater. The
following are signs associated with NUG that are
not normally present with marginal gingivitis.
The most characteristic sign of NUG is ulcera-
tion and cratering of the interdental papillae.
Frequently, so much of a papilla is lost that the
triangular area between the crowns of the teeth
presents a punched out appearance. In addition,
you may detect the following.
Gray-white membrane covering the gingivae
Figure 2-13.Necrotizing ulcerative gingivitis.
Foul odor from the oral cavity
Pus oozing from the gingivae
Areas of gingival recession
TREATMENTTreat NUG in the same way as
marginal gingivitis, but referral to a dental
treatment facility is more important than in
This is an inflammatory condition that in-
volves the gingivae, the crest of the aleolar bone,
and the periodontal membrane above the alveolar
crest as shown in figure 2-14. It usually develops
as a result of untreated marginal gingivitis. The
disease is marked by a gradual recession of the
periodontal tissues. Tooth mobility may also occur.
Periodontitis may affect the entire dentition or
only localized areas.
SYMPTOMSThe patient may complain of
any of the following.
Deep, gnawing pain in the affected area
Itchiness of the gums
Sensitivity to heat and cold