it is very simple description to NUG and NUP , i hope it will be very useful for every one ,

1. *Necrotizing Ulcerative
Gingivitis (NUG)
* Necrotizing Ulcerative
Periodontitis (NUP)

2. Necrotizing periodontal diseases

3. Necrotizing periodontal diseases
Stages of oral necrotizing disease –
by Horning & Cohen

4. Definition of NUG
– Necrotizing ulcerative gingivitis (NUG) is a
microbial disease of the gingiva in the context of
an impaired host response.
– It is characterized by the necrosis and sloughing
of gingival tissue, and it presents with
characteristic signs and symptoms.

5. Etiology
✓Role of Bacteria: mixed bacterial infection that includes
anaerobes such as P. intermedia and fusobacterium as
well as spirochetes.
✓Role of the host response: the presence of these
organisms appears to be insufficient to cause the
disease, All of the predisposing factors for NUG are
associated with immunosuppression.

6. Predisposing factor
1- Local:
*Preexisting gingivitis.
*Injury to the gingiva.
*Smoking.
2-Systemic:
*Nutritional Deficiency.
*Systemic disease
(e.g., syphilis, cancer).
3-Psychological:
*Stressful
situations.
*Psychologic
disturbances.

7. Clinical features (oral signs – oral
symptoms)
at the crest of the
interdental papillae
that subsequently
extend to the
marginal gingiva.
1
Surface of the
gingival craters is
covered by a
slough.
red, shiny, and
hemorrhagic surface.
2
NUG can occur in
otherwise disease-
free mouths, or it
can be superimposed
on chronic gingivitis
or periodontal
pockets
3

8. Oral signs
– punched-out, craterlike
depressions
– grayish
pseudomembrane

9. Symptoms
▪ The lesions are extremely sensitive to touch.
▪ Constant radiating pain.
▪ There is a “metallic” foul taste.
▪ Excessive amount of “pasty” saliva.

10. Clinical Course
The clinical course can vary. If untreated, NUG may lead to
a progressive destruction of the periodontium as well as
gingival recession accompanied by an increase in the
severity of systemic complications.

11. Management and treatment
First visit
• A topical anesthetic is applied.
• After 2-3 minutes, the areas are gently swabbed with a moistened
cotton pellet to remove the pseudomembrane.
• The area is cleansed with warm water.
• The supragingival calculus is removed with ultrasonic scalers.
• Instructions:
1.Removal of surface debris with ultrasoft brush.
2.Rinsing twice daily with 0.12% chlorhexidine solution.
3.Patients with systemic complications need supportive treatment.
4.Avoiding smoking & tobacco.

12. Management and treatment
Second visit
• 1 or 2 days after the first visit.
• The pain is diminished or no
longer present.
• Shrinkage of the gingiva may
expose previously covered
calculus, which is gently
removed.
• Repeating the previous
instructions.
Third visit
• 5 days after the second visit.
• Chlorhexidine rinses can be
maintained for 2 or 3 weeks.
• Scaling and root planing are
repeated if necessary.
• The patient should be
reevaluated at one month to
determine his compliance.

13. Necrotizing
Ulcerative
Periodontitis
✓ Extension of NUG in which bone
loss and periodontal attachment
loss occurs.
✓ Soft tissue necrosis, rapid
periodontal destruction, and
interproximal bone loss.
✓ Usually localized to a few teeth.
✓ Bone is often exposed, which
results in necrosis and subsequent
sequestration.

14. Management
&
Treatment
Local debridement; scaling and root planing; in-office
irrigation with an effective antimicrobial agent such as
chlorhexidine gluconate.
Maintaining oral hygiene, including the home use of
antimicrobial rinses.
In patients with severe NUP, antibiotic therapy may be
necessary, but it should be used with caution in HIV-
infected patients.
Metronidazole (250 mg, with two tablets taken immediately
and then two tablets taken four times daily for 5 to 7 days) is
the drug of choice.
The prophylactic prescription of a topical or systemic
antifungal agent is prudent if an antibiotic is used.

15. “ Simplicity is the glory of
expression ”
Walt Whitman
Thank you