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Establishment of drainage tends to reduce the acute symptoms. 1-39. NECROTIZING ULCERATIVE GINGIVITIS Necrotizing ulcerative gingivitis (NUG), commonly called "trench mouth" or Vincent's disease, is a bacterial infection. It is usually associated with poor oral hygiene, smoking, and/or psychological stress, but may be seen in patients with good oral hygiene. a.Cause.Although the exact cause of the disease is unknown, it is accompanied by an increase in the numbers of two organisms, the fusiform bacillus and medium-size spirochetes (Vincent's spirillum). It is doubtful that NUG is readily communicable. Instruction in oral hygiene is not only an important preventive measure but also an essential phase of the treatment. The infecting organisms can successfully invade and grow only in tissues whose resistance has been lowered. Therefore, proper diet, rest, exercise, and adequate oral hygiene can be good preventive measures. b.Effect.Necrotizing ulcerative gingivitis is characterized by fetid breath and ulcerations covered by a whitish, yellowish, or gray pseudomembrane. They may be found in only a few areas or throughout the mouth. The most common site of these ulcers is the interproximal gingiva. The thin gray membrane covering the ulcer may be wiped off easily, exposing a highly inflamed area that bleeds very easily. There is a rapid destruction of the marginal and interproximal soft tissue. These tissues become so painful that it becomes difficult to brush the teeth and to masticate food. The onset of this infection is sudden, often with systemic symptoms of illness. In severe cases, there may be fever, an increased pulse rate, pallor of the skin, insomnia, and mental depression. Treatment includes procedures performed by the dental officer and home-care procedures performed by the patient. MD0511 1-18
1-40. PERICORONITISPericoronitis is an inflammatory process occurring in gingival tissue found around the coronal (crown) portion of the teeth, particularly around partially erupted teeth. Similarly, operculitisis an inflammation of the gingival tissue flaps (operculi) found over partially erupted teeth. The most frequent site is the mandibular third molar region. The heavy flap of gingival tissues covering portions of the tooth crown of the tooth makes an ideal pocket for debris accumulation and bacterial incubation. In the acute phase, pain and swelling in the area are prominent features. Symptoms of a sore throat and difficulty in swallowing may be present. A partial contraction of muscles of mastication, causing difficulty in opening the mouth (trismus), may also be experienced. Abscess formation in the area may occur, leading to marked systemic symptoms of general malaise and fever. Treatment should be directed toward careful cleansing of the pocket area and followup care with warm saline irrigations. Antibiotic therapy may be indicated if the condition warrants. The prognosis for retention of the tooth is dependent upon the possibility of complete elimination of the inflammation and elimination of the gingival