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Necrotizing Ulcerative Gingivitis, Emergency Medicine

Stephen K. Epstein and Laura B. Glicksman Reviewed 06/2017
 


Basics

Description

  • Periodontal disease

  • Characterized by the “punched-out” appearance of the gingival papillae

  • Synonym(s):

    • Acute necrotizing ulcerative gingivitis

    • Trench mouth

    • Vincent disease

    • Fusospirochetal ...

Diagnosis

Signs and Symptoms

  • Essential clinical features:

    • Painful gingival lesions

    • “Punched-out,” crater-like ulcers of the papillae

    • Ulcers bleed easily or spontaneously

  • Nonessential clinical features:

    • “Pse...

Treatment

Initial Stabilization/Therapy

IV fluids for dehydration 

Ed Treatment/Procedures

  • Administer systemic and topical pain management:

  • Debride pseudomembran...

Follow-Up

Disposition

Admission Criteria

  • Extensive disease with systemic signs

  • Severe dehydration/inability to tolerate PO fluids

  • Evidence of orofacial gangrene (noma): Infection of mouth/face:

    • 70% mortali...

Pearls and Pitfalls

  • Consider HIV or immunosuppression

  • If untreated, can progress rapidly

Additional Reading

  • Bermejo-Fenoll  A, Sánchez-Pérez  A. Necrotising periodontal diseases. Med Oral Patol Oral Cir Bucal.  2004;9(suppl):108–114.

  • Califano  JV. Position paper: Periodontal diseases ...

Codes

ICD9

  • 101 Vincent's angina

  • 526.4 Inflammatory conditions of jaw

  • 528.1 Cancrum oris

ICD10

  • A69.0 Necrotizing ulcerative stomatitis

  • A69.1 Other Vincent's infections

  • M27.2 Inflammatory conditions of jaws

SNOMED

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