Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical
  • Published:

Necrotising periodontal diseases: an update on classification and management

British Dental Journal volume 233, pages 855–858 (2022)Cite this article

Abstract

Necrotising periodontal diseases can present with significant morbidity and, whilst unusual, they are not entirely uncommon in primary care. With this in mind, members of the dental team should be aware of relatively recent changes to the classification and management of these diseases to optimise patient outcomes. Similarly, understanding the bacteriology, patterns of tissue breakdown, and management and maintenance of these conditions will allow clinicians to manage these diseases should they present. The progression of necrotising diseases in Sub-Saharan Africa to present as noma is also discussed. The objective is to help the reader understand the classification and management of necrotising periodontal diseases.

Key points

  • Gives an update on necrotising periodontal diseases, relevant to the whole dental team.

  • Provides tips on how to manage these conditions.

  • Offers an understanding of the presentation of necrotising periodontal diseases from an African perspective.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. West N, Chapple I, Claydon N et al. BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. J Dent 2021; 106: 103562.

  2. Jia J, Zhou Y, Wang X, Liu Y. Subgingival microbiome dynamic alteration associated with necrotizing periodontal disease: A case report. Medicine (Baltimore) 2021; DOI: 10.1097/MD.0000000000024311.

  3. American Academy of Periodontology. 2017 Classification of Periodontal and Peri-implant Diseases and Conditions. 2017. Available at https://www.perio.org/2017wwdc (accessed September 2020).

  4. Annals of Periodontology. 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. Papers. Oak Brook, Illinois, October 30 - November 2, 1999. Ann Periodontol 1999; 4: 1-112.

  5. Papapanou P, Sanz M, Buduneli N et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018; DOI: 10.1002/JPER.17-0721.

  6. Rowland R W. Necrotising ulcerative gingivitis. Ann Periodontol 1999; 4:65-73.

  7. Listgarten M A. Electron microscopic observations on the bacterial flora of acute necrotising ulcerative gingivitis. J Periodontol (1930) 1965; 36: 328-339.

  8. Heylings R T. Electron microscopy of acute ulcerative gingivitis (Vincent's type). Demonstration of the fusospirochaetal complex of bacteria within pre-necrotic gingival epithelium. Br Dent J 1967; 122: 51-56.

  9. Courtois G J 3rd, Cobb C M, Killoy W J. Acute necrotising ulcerative gingivitis. A transmission electron microscope study. J Periodontol 1983; 54: 671-679.

  10. Riviere G R, Wagoner M A, Baker-Zander S A et al. Identification of spirochetes related to Treponema pallidumin necrotising ulcerative gingivitis and chronic periodontitis. N Engl J Med 1991; 325:539-543.

  11. Riviere G R, Weisz K S, Simonson L G, Lukehart S A. Pathogen-related spirochetes identified within gingival tissue from patients with acute necrotising ulcerative gingivitis. Infect Immun 1991; 59:2653-2657.

  12. Dewhirst F E, Tamer M A, Ericson R E et al. The diversity of periodontal spirochetes by 16S rRNA analysis. Oral Microbiol Immunol 2000; 15: 196-202.

  13. Loesche W J, Syed S A, Laughon B E, Stoll J. The bacteriology of acute necrotising ulcerative gingivitis. J Periodontol 1982; 53:223-230.

  14. Journal of the Canadian Dental Association. Managing Patients With Necrotizing Ulcerative Periodontitis. 2013. Available at https://jcda.ca/article/d44 (accessed February 2022).

  15. Ahlgren M, Funk T, Marimo C, Ndiaye C, Alfvén T. Management of noma: practice competence and knowledge among healthcare workers in a rural district of Zambia. Glob Health Action 2017; 10: 1340253.

  16. World Health Organisation. Oral health. 2022. Available at https://www.who.int/news-room/fact-sheets/detail/oral-health (accessed February 2022).

  17. Malek R, Gharibi A, Khlil N, Kissa J. Necrotizing Ulcerative Gingivitis. Contemp Clin Dent 2017; 8: 496-500.

  18. National Institute for Health and Care Excellence. Scenario: Acute necrotizing ulcerative gingivitis. 2021. Available at https://cks.nice.org.uk/topics/gingivitis-periodontitis/management/acute-necrotizing-ulcerative-gingivitis/ (accessed February 2022).

  19. Gasner N S, Schure R S. Necrotizing Periodontal Diseases. Florida: StatPearls Publishing, 2022.

  20. Falkler W A Jr, Martin S A, Vincent J W, Tall B D, Nauman R K, Suzuki J B. A clinical, demographic and microbiologic study of ANUG patients in an urban dental school. J Clin Periodontol 1987; 14: 307-314.

  21. Suenaga H, Saijo H, Chikazu D et al. Necrotising Ulcerative Stomatitis in a Neutropenic Patient with Malignant Lymphoma. Asian J Oral Maxillofac Surg 2008; 20: 196-200.

  22. Feller L, Khammissa R A G, Altini M, Lemmer J. Noma (cancrum oris): An unresolved global challenge. Periodontol 2000 2019; 80: 189-199.

  23. World Health Organisation. Noma is a severe disease: It is treatable if detected and managed early. 2016. Available at https://www.afro.who.int/sites/default/files/2017-07/Information_brochure_EN.pdf (accessed October 2022).

  24. Farley E, Oyemakinde M J, Schuurmans J et al. The prevalence of noma in northwest Nigeria. BMJ Glob Health 2020; DOI: 10.1136/bmjgh-2019-002141.

  25. Farley E, Mehta U, Srour M L, Lenglet A. Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021). PLoS Negl Trop Dis 2021; DOI: 10.1371/journal.pntd.0009844.

  26. ZeroNOMA. Available at https://zeronoma.org/ (accessed March 2022).

Download references

Author information

Authors and Affiliations

  1. Bachelor of Dental Surgery, Peninsula Dental School, Plymouth, UK

    Rachel Ogunleye, Obioma Ukoha & Weronika Nasterska

  2. Director of Clinical Dentistry, Peninsula Dental School, University of Plymouth, UK

    Ewen McColl

  3. Doctor of Dental Medicine, Endodontics, Head Dental Unit, CBN Diagnostic and Treatment Centre, Kano, Nigeria

    Fatima Dantata

  4. Bachelor of Dental Surgery, Third Year Resident, Preventive Dentistry Department, Aminu Kano Teaching Hospital, Nigeria

    Ifeoluwa Adetula

Authors
  1. Rachel Ogunleye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Obioma Ukoha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weronika Nasterska
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ewen McColl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fatima Dantata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ifeoluwa Adetula
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ewen McColl had the idea to write a paper on this subject matter and edited contributions from Rachel Ogunleye, Obioma Ukoha and Weronika Nasterska. Images of NP were provided from an undergraduate clinic at Peninsula Dental School. Fatima Dantata and Adetula Ifeoluwa wrote the section on noma and provided all images of noma.

Corresponding author

Correspondence to Ewen McColl.

Ethics declarations

The authors declare no conflicts of interest.

Written consent to publish was obtained for Figure 3.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ogunleye, R., Ukoha, O., Nasterska, W. et al. Necrotising periodontal diseases: an update on classification and management. Br Dent J 233, 855–858 (2022). https://doi.org/10.1038/s41415-022-5201-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-022-5201-y

This article is cited by

Search

Advanced search

Quick links