1. DR.HINA ADNAN

2.  DEFINITION ( NPD): is an inflammatory infection of periodontal tissue that involve tissue necrosis ( localized tissue death).  Division : can be divided into: 1. Necrotizing Ulcerative Gingivitis (NUG). 2. Necrotizing Ulcerative Periodontitis (NUP).

5.  The clinical appearance of necrotizing disease is noticeably different than that of any other periodontal disease.  NPD is painful infection, primarily involving the interdental and marginal gingiva.  Is characterized by ulcerated and necrotic papillae and gingival margin.  The necrotic areas of gingiva are covered by a yellowish white or grayish tissue slough which is termed pseudomembrane.

6.  The necrotizing lesions develop rapidly and are painful.  The first lesion often are seen interproximally in the mandibular anterior sextant but may occur in any interproximal papilla. It swell rapidly and develop a rounded contour.  Oral odor ( bad breath ).  The disease may be associated with excessive salivation.

8.  Systemic signs & symptoms:  Swelling of lymph nodes especially the submandibular and cervical lymph nodes.  Fever and malaise.

9.  Etiology: 1-Micro organism: associated with Treponema species, Selenomonas species, Fusobacterium species. 2-Predisposing factors for NPD:  Systemic disease (HIV infection, leukemia,measles,chicken pox, TB,)  Poor self care ( plaque biofilm control)  Emotional stress.  Inadequate sleep, fatigue.  Alcohol use.  Cigarette smoking.  Poor nutrition.  Preexisting gingivitis or tissue trauma.  Young age ( 22 and 24 year)

10.  Necrotizing Ulcerative Gingivitis ( NUG):  Can be defined as tissue necrosis that is limited to the gingival tissue.  Characteristics: (clinical signs) 1. Painful with ulceration. 2. Necrosis of interdental papilla ( cratered punched-out papilla) 3. Yellowish white or grayish tissue slough. 4. Spontaneous bleeding or with gentle touch. 5. Sudden onset. 6. Swelling and sloughing off of dead epithelial tissue from the gingiva.

11.  Necrotizing ulcerative periodontitis (NUP):  Can be defined as an infection characterized by necrosis of gingival tissue, periodontal ligament and alveolar bone.  Same signs and symptoms of NUG  Attachment loss.

13.  Treatment :  Is divided into 2 phases: 1. Acute. 2. Maintenance.

14.  Acute phase: the goal of acute phase treatment is to eliminate disease activity & relieve pain and discomfort. 1. Periodontal instrumentation: ultrasonic may be preferable with minimal pressure against the tissue. 2. Patient self care instruction: tooth brushing should be avoided in areas of open wounds to promote wound healing. Twice daily rinsing with 0.12% chlorhexidine solution is very effective. 3. Adjunctive oxygen therapy : for the management of systemic manifestation (fever, swollen lymph nodes)

15.  Maintenance ( pt education):  Instruction should include proper nutrition, intake of fluids and smoking cessation.