Acute Necrotizing Periodontitis: A Case Report

Case Report

Austin J Dent. 2016; 3(3): 1041.

Acute Necrotizing Periodontitis: A Case Report

Assimi S, Abdallaoui L and Ennibi OK*

Department of Periodontology, Mohammed V University in Rabat, Morocco

*Corresponding author: Ennibi Oumkeltoum, Department of Periodontology, Faculty of Dental Medicine, Mohammed V University in Rabat, BP 6212, Rabat, Morocco

Received: June 14, 2016; Accepted: August 22, 2016; Published: August 24, 2016


Necrotizing periodontal diseases are the most severe inflammatory periodontal disorders caused by bacterial plaque. The diagnosis is based on clinical and radiological features. Necrotizing periodontitis lesions are confined to periodontal tissues, including gingiva, periodontal ligament, and alveolar bone. The pathognomonic clinical characteristics are the typical punched out appearance and interproximal craters. In this case report, we presented a 20- year old man with necrotizing periodontitis and no systemic disease with a history of tobacco use and intense stress. The case was managed by conservative oral treatment and regular psychological follow up.

Keywords: Necrotizing periodontitis; Diagnosis; Treatment


Necrotizing periodontal diseases (NPD) are the most severe inflammatory periodontal disorders caused by bacterial plaque and usually run an acute course [1]. They are classified as necrotizing gingivitis, periodontitis, or stomatitis, and they appear to represent various stages of the same disease [2]. Clinical features in necrotizing periodontitis (NP) are characterized by the presence of punchedout, ulcerated and necrotic lesions that may be covered by a pseudomembrane of necrotic tissue [3]. The ulcerations are extremely painful and show spontaneous bleeding [4]. An important feature of NP is the rapid and severe loss of clinical attachment and alveolar bone within a few days or weeks [1]. Other possible clinical features include the presence of oral halitosis, adenopathies, fever, and/or general discomfort [5].

In developing countries, the prevalence of NPD is higher than in the industrialized countries, however, the prevalence of these diseases has declined significantly during the twentieth century [6]. The disease frequently occurs in children and young adults, military persons and slightly more often among HIV-infected individuals [1,7]. The prevalence of NP seems to be low and decreases with age. Its occurrence in systemically healthy population is difficult to estimate since most studies of necrotic oral lesions have failed to differentiate between necrotizing gingivitis and necrotizing periodontitis based on the presence or absence of attachment loss and bone loss at affected sites [8]. Nonetheless, in HIV-seropositive individuals, the prevalence of NP was about 2% to 6% [9]. This low prevalence may be explained by the introduction of the antiretroviral therapy [10] which makes no difference between this patient’s category and the general population [1].

Factors causing NP are not clearly established. It may be a consequence of necrotizing ulcerative gingivitis or as a history of previous occurring NP [11,12]. However, a combination of etiological factors may play a role in its pathogenesis [13] such as Human Immunodeficiency Virus (HIV), diabetes, leukemia, poor oral hygiene, intense and prolonged psychological stress with insufficient rest and recent illness, nutritional deficiency, alcohol abuse and smoking [2,12,14]. Here, we report a case of an acute necrotizing periodontitis, describing the clinical features, treatment approach, and successful outcomes.

Case Presentation

A 20-year-old male patient was referred to the Clinical Department of Periodontology, at the center of consulting and dental treatment, Ibn Sina hospital in Rabat, Morocco, with complaint of intense and persistent oral pain, gingival bleeding and fetid breath for two weeks. Because of the extremely pain, the patient reported that he didn’t slept for two days and stopped eating for four days. In addition to that, he didn’t have a regular oral hygiene and he stopped tooth brushing since the pain started. He weighed 60 kg and was 182 cm tall and claimed having weight loss since one month (6 Kg).

The patient was otherwise systemically healthy with no medical history of interest. He was a heavy smoker for 6 years (20 cigarettes per day), he also used to chew tobacco and consume alcohol. He declared having had unprotected sex and had been experiencing heavy stress due to family problems.

On extraoral examination, bilateral submandibular lymph nodes were tender on palpation and a rise in body temperature was detected.

On intraoral examination, poor oral hygiene was noticed with plaque, heavy calculus deposits, visible suppuration and severe halitosis. The oral lesions were extremely painful hindering periodontal probing. Examination of the gingiva revealed a thin whitish film (pseudo-membrane) that covered a part of the attached gingiva with bleeding on slight stimulation. Ulcerations and tissue necrosis were almost generalized and severe dividing the papillae into separate edges one facial and one lingual portion with an interposed necrotic depression producing considerable tissue destruction and formation of characteristic punched out crater like depressions with exposition of the interdental bone (Figure 1A,B and C).