Necrotizing periodontal disease: what it is, causes and treatment

Necrotizing periodontal diseases are a group of inflammatory gum diseases, characterized by a sudden onset and extensive destruction of the supporting tissues of the teeth, that is, the gums and bone. It mostly affects people between the ages of 20 and 30.

Necrotizing periodontal disease is caused by an overgrowth of bacteria . However, many of the causative bacteria are found in everyone’s normal bacterial flora without causing any harm. For necrotizing periodontal disease to occur, a systemic commitment of the patient is also necessary . There are several factors that increase the risk of suffering from necrotizing periodontal disease, the main ones being:

• Poor hygiene
• Malnutrition
• Alcoholism
• Smoking
• Blood disorders such as neutropenia or anemia
• Leukemia
• VIH.

This disease is not transmitted , however, it is usually seen in several individuals of the same group, since they generally share several risk factors , such as in underdeveloped populations where malnutrition and poor hygiene are shared, in addition to others. factors.

The first region that is affected by necrotizing periodontal disease is that corresponding to the interdental papillae , which is the projection of the gums in a triangular shape that are between one tooth and another. Begins as a u ulcer shaped crater, which is surrounded by an inflamed and reddened region. The gingiva that covers the third molars (wisdom teeth) that are in the process of eruption, and the one that is close to restorations in poor condition are also usually the starting point of necrotizing periodontal disease.

These ulcers are usually covered by a yellowish-gray membrane , characteristic of the bacteria that cause the disease. By removing this layer, bleeding occurs and the painful surface of the ulcer is exposed.

The pain is a consistent symptom, and which often leads to the person concerned to go to the dentist. This pain is described as burning or strong tension, and is usually severe pain that intensifies with chewing, spicy or hot foods, and brushing. As a result of the latter, patients with necrotizing periodontal disease tend to deteriorate their hygiene, which causes the disease to progress more rapidly .

The presence of ulcers and poor hygiene produces an inflammation of the gums , which manifests as bleeding which can be caused or spontaneous. Other symptoms of necrotizing periodontal disease are:

• Bad breath ( halitosis ).
• Bad mouth taste.
• Excessive salivation (hypersalivation).
• Swelling of the lymph nodes.
• Fever and malaise.

Although the disease begins in the gum, when it is not controlled it continues to advance until it compromises other tissues of the mouth. This gives rise to a classification of necrotizing periodontal disease depending on the type of tissue it affects:

• Necrotizing gingivitis : when limited only to the papilla or gingival margins
• Necrotizing periodontitis : the infection progresses to the supporting tissues, affecting the ligament and bone of the tooth, causing it to loosen.
• Necrotizing stomatitis : the disease progresses to affect the mucosa beyond the gums, such as the inner part of the cheeks
• Noma or cancrum oris : it is an extremely rare situation, which is seen practically only in populations with the worst living conditions. It involves an invasion of the infection into the tissues of the face, producing significant disfigurement. It is a frequently fatal condition.

Because necrotizing periodontal disease has very characteristic symptoms, the diagnosis is usually made only with the clinical findings and the patient’s description of the evolution of the disease, and no blood tests or other tests are usually necessary to make the diagnosis.

However, sometimes a bacterial smear is useful to differentiate the disease from other conditions that cause ulceration of the tissues of the mouth, such as herpetic stomatitis. Blood tests are useful to identify possible systemic alterations in the affected person, which could have given rise to periodontal necrotizing disease.

The treatment of necrotizing periodontal disease is divided into four phases :

1. Emergency or acute phase treatment: the goal is to eliminate pain and control the progression of the disease. It consists of a local treatment, which consists of daily visits to the dentist to remove plaque and dental calculus, and to replace brushing with the use of hydrogen peroxide (hydrogen peroxide) mixed with water to reduce the amount of bacteria, and a systemic treatment that involves the use of antibiotics (preferably metronidazole) and analgesics.
2. Treatment of predisposing factors: consists of controlling the possible causes of the bacterial imbalance that caused necrotizing periodontal disease: eliminating tobacco and alcohol, improving nutrition and oral hygiene, and consulting with specialists to treat systemic diseases.
3. Correction of tissue deformities: due to the formation of ulcers in necrotizing gingivitis, the gums are left with defects that can predispose to the accumulation of plaque and calculus and therefore, to the appearance of other gum diseases. Similarly, the presence of deeper tissue defects is normal in cases of necrotizing periodontitis. Surgical interventions are necessary to correct these defects
4. Maintenance phase: once the disease has been controlled and the symptoms have been eliminated, the patient should be explained that periodic visits to the dentist are necessary to verify that the disease does not reappear. Necrotizing periodontal disease is a condition that can be easily solved if it is intervened in its early stages, but it is also characterized by having a high recurrence rate when patients do not comply with the indications.

This article is merely informative, at FastlyHeal .com we do not have the power to prescribe medical treatments or make any type of diagnosis. We invite you to see a doctor in the case of presenting any type of condition or discomfort.

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