ABSTRACT
Noma (cancrum oris) is a destructive necrotising disease affecting orofacial tissues predominantly of malnourished young children. It is characterised by a rapid acute onset which usually starts in the mouth, spreads intra-orally destroying soft tissue and bone and progresses to perforate the facial skin, causing disfigurement. Polybacterial anaerobic infection is critical too, but is not alone sufficient for the initiation of noma. Cofactors, first and foremost malnutrition, but also systemic viral and bacterial infections are crucial to the development of noma. A patient with necrotising stomatitis or noma must be admitted to hospital for antibiotic treatment, fluid and electrolytes as well as nutritional supplementation and general supportive treatment. The epidemiology of noma in the South African population is unknown, and the clinicopathological features are poorly characterised. Although worldwide there is no evidence that HIV infection is a strong risk factor for noma, HIV infection may play a substantial role in the pathogenesis of noma in South Africa.
Subject(s)
Noma/etiology , Adult , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Disease Progression , Female , Gingivitis, Necrotizing Ulcerative/physiopathology , Humans , Male , Noma/physiopathology , Noma/therapy , Risk Factors , South AfricaABSTRACT
Acute Necrotizing Ulcerative Gingitivitis (ANUG) is a distinct and specific disease. This disease entity has been described as far back as the days of Hippocrates and is known by many synonyms. With the advent of antibiotics and with improved nutritional status, the incidence has decreased and even become extinct in developed countries. However, with the increasing incidence of severe immunodeficiency states such as seen in Acquired Immunodeficiency Syndrome (AIDS) the lesion has once more, become a well recognized and often encountered clinical entity in developed countries. In developing countries, however, the condition is still a commonly diagnosed clinical lesion because of the persistently poor nutritional status. Because of the current campaign for increased focus on global health issues, ANUG, a lesion of significant interest for the developing countries where malnutrition is high and for developing countries because of the AIDS, a global pandemic has resurfaced as a topic for discussions and study. This literature review will provide a better understanding of the epidemiology, etiology, and pathophysiology of ANUG associated with malnutrition.
Subject(s)
Gingivitis, Necrotizing Ulcerative/etiology , Malnutrition/complications , Africa South of the Sahara/epidemiology , Child , Child, Preschool , Gingivitis, Necrotizing Ulcerative/epidemiology , Gingivitis, Necrotizing Ulcerative/physiopathology , HIV Infections/complications , Humans , Young AdultABSTRACT
OBJECTIVES: This manuscript attempts to critically review current literature regarding the natural history, aetiology and pathogenesis of the common periodontal diseases to affect children and adolescents. The logic behind the emergence of a new classification in the early 1990s is explained and potential problems with the interpretation of such systems outlined. DATA SOURCES: The manuscript focuses upon recent developments, reported in the international periodontal literature, aimed at unraveling the molecular basis for this group of diseases. The concept of one disease type progressing with time to another disease within the same individual is discussed, and early data presented that indicate the possibility of microbial transmission from deciduous to permanent dentition's within a subject. CONCLUSIONS: It is concluded that differing classification systems for adolescent and childhood periodontal diseases may lead to confusion within the dental profession, unless the clinical and molecular basis for such diseases is fully understood. Further advances in basic research using molecular biology tools should assist in our understanding of the aetiopathology at a molecular level and hopefully lead to the development of new treatment strategies.
Subject(s)
Periodontal Diseases/physiopathology , Adolescent , Aggressive Periodontitis/physiopathology , Bacterial Physiological Phenomena , Child , Chronic Disease , Disease Progression , Gingivitis/physiopathology , Gingivitis, Necrotizing Ulcerative/physiopathology , Humans , Molecular Biology , Periodontal Diseases/classification , Periodontal Diseases/etiology , Periodontal Diseases/microbiology , Periodontal Diseases/therapy , Tooth/microbiology , Tooth, Deciduous/microbiologyABSTRACT
Behçet's disease is a complex multisystem disease of unknown origin. It presents clinically as oral, pharyngeal, and genital ulcerations, uveitis, and inflammatory papulopustules. Diagnosis is made clinically since laboratory and histologic observations are not specific. We present a patient who, despite the absence of eye and genital lesions, seems best viewed as having Behçet's disease.
Subject(s)
Behcet Syndrome/diagnosis , Gingivitis, Necrotizing Ulcerative/diagnosis , Skin Diseases, Vesiculobullous/diagnosis , Adolescent , Behcet Syndrome/physiopathology , Biopsy, Needle , Diagnosis, Differential , Facial Dermatoses/diagnosis , Facial Dermatoses/physiopathology , Female , Gingivitis, Necrotizing Ulcerative/physiopathology , Humans , Skin Diseases, Vesiculobullous/physiopathologySubject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Otitis Media with Effusion/diagnosis , Otitis Media/drug therapy , Pharyngitis/microbiology , Tonsillectomy/standards , Adenoidectomy/standards , Algorithms , Cellulitis/complications , Cellulitis/drug therapy , Cellulitis/microbiology , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/etiology , Rheumatic Fever/epidemiology , Rheumatic Fever/prevention & control , Gingival Crevicular Fluid/microbiology , Gingivitis, Necrotizing Ulcerative/drug therapy , Gingivitis, Necrotizing Ulcerative/physiopathology , Tympanic Membrane/surgery , Otitis Media/diagnosis , Otitis Media/etiology , Pharyngitis/diagnosis , Pharyngitis/etiology , Sinusitis/diagnosis , Sinusitis/drug therapy , Sinusitis/physiopathology , Streptococcus pyogenes/pathogenicitySubject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pharyngitis/microbiology , Tonsillectomy/standards , Otitis Media/drug therapy , Otitis Media with Effusion/diagnosis , Pharyngitis/diagnosis , Pharyngitis/etiology , Rheumatic Fever/epidemiology , Rheumatic Fever/prevention & control , Otitis Media/diagnosis , Otitis Media/etiology , Adenoidectomy/standards , Tympanic Membrane/surgery , Algorithms , Streptococcus pyogenes/pathogenicity , Gingivitis, Necrotizing Ulcerative/physiopathology , Gingivitis, Necrotizing Ulcerative/drug therapy , Gingival Crevicular Fluid/microbiology , Sinusitis/diagnosis , Sinusitis/physiopathology , Sinusitis/drug therapy , Cellulite/drug therapy , Cellulite/microbiology , Cellulite/complications , Fasciitis, Necrotizing/etiology , Fasciitis, Necrotizing/drug therapyABSTRACT
Analyzes the results of hemoperfusion used in multiple-modality treatment of 33 patients with grave forms of stomatitis. Enumerates indications for such therapy, methods of homeostasis control, and for assessment of hemoperfusion efficacy. Reduction of treatment periods from 23.4 days in controls to 19.0 days in experimental group indicate a high efficacy of hemoperfusion in the treatment of grave stomatitis.
Subject(s)
Gingivitis, Necrotizing Ulcerative/therapy , Hemoperfusion , Adolescent , Adult , Aged , Combined Modality Therapy , Female , Gingivitis, Necrotizing Ulcerative/complications , Gingivitis, Necrotizing Ulcerative/physiopathology , Homeostasis , Humans , Male , Middle Aged , Remission Induction , Staphylococcal Skin Infections/therapy , Stevens-Johnson Syndrome/therapy , Time FactorsABSTRACT
Anecdotal reports have suggested that painful gingivitis may be associated with infection due to the human immunodeficiency virus (HIV). Twenty patients who presented to the emergency department with a chief complaint of gum pain were evaluated for HIV infection, CD4/CD8 T lymphocyte profiles, complete blood cell counts and differentials, and lymphocyte function (response to mitogenic stimulation). Seven of the 20 patients (35%) were seropositive for HIV. Three of the seven HIV-seropositive patients were unaware of their HIV infection until tested in this study (with use of an ELISA and western blotting). The HIV-seropositive patients were significantly older than the HIV-seronegative patients (31.4 +/- 3 years and 24 +/- 1 year, respectively). Two of the seven HIV-seropositive patients presented with severe CD4 lymphocyte depletion. The other five HIV-seropositive patients presented with CD4 lymphocyte counts of 473 +/- 155 (mean +/- SE). Regardless of HIV serological status, all patients demonstrated a severely depressed mitogenic response when compared with control subjects. There were no remarkable differences in complete blood cell counts and differentials within each serological group. Significant differences, however, were noted when CD4/CD8 lymphocyte counts and ratios were measured. Identification of clinical presentations, such as painful gingivitis, that reflect an early stage of HIV infection could aid in the timing of therapy and prevention of the spread of HIV infection.
Subject(s)
Gingivitis, Necrotizing Ulcerative/complications , HIV Infections/complications , Adult , CD4-CD8 Ratio , CD4-Positive T-Lymphocytes , Female , Gingivitis, Necrotizing Ulcerative/immunology , Gingivitis, Necrotizing Ulcerative/physiopathology , HIV Infections/blood , HIV Infections/immunology , HIV Seropositivity/blood , HIV Seropositivity/complications , HIV Seropositivity/immunology , Humans , In Vitro Techniques , Leukocyte Count , Lymphocyte Activation , Male , Pain/physiopathologyABSTRACT
La mucosa oral es frecuentemente asiento de lesiones vinculadas a enfermedades sistémicas, y dentro de éstas destacamos las discrasias sanguíneas. Se estudiaron en el Hospital de Clínicas José de San Martín, 15 pacientes con patologías de la mucosa oral cuyas enfermedades de base fueron leucemia, aplasia medular y linfoma. De estos, 10 presentaron manifestaciones hemorragíparas, 7 pacientes con lesiones ulceronecróticas y 2 casos de hipertrofia gingival por infiltración neoplásica
Subject(s)
Hematologic Diseases/complications , Oral Manifestations , Anemia, Aplastic/complications , Candidiasis, Oral , Ecchymosis/physiopathology , Gingival Hemorrhage/physiopathology , Gingival Hypertrophy/physiopathology , Gingivitis, Necrotizing Ulcerative/physiopathology , Gingivitis/physiopathology , Leukemia, Lymphoid/complications , Leukemia, Myeloid/complications , Lymphoma, Non-Hodgkin/complications , Necrosis/physiopathology , Purpura/physiopathology , Stomatitis/physiopathologyABSTRACT
La mucosa oral es frecuentemente asiento de lesiones vinculadas a enfermedades sistémicas, y dentro de éstas destacamos las discrasias sanguíneas. Se estudiaron en el Hospital de Clínicas José de San Martín, 15 pacientes con patologías de la mucosa oral cuyas enfermedades de base fueron leucemia, aplasia medular y linfoma. De estos, 10 presentaron manifestaciones hemorragíparas, 7 pacientes con lesiones ulceronecróticas y 2 casos de hipertrofia gingival por infiltración neoplásica
Subject(s)
Hematologic Diseases/complications , Oral Manifestations , Lymphoma, Non-Hodgkin/complications , Leukemia, Myeloid/complications , Leukemia, Lymphoid/complications , Anemia, Aplastic/complications , Necrosis/physiopathology , Gingival Hemorrhage/physiopathology , Gingival Hypertrophy/physiopathology , Gingivitis/physiopathology , Gingivitis, Necrotizing Ulcerative/physiopathology , Ecchymosis/physiopathology , Purpura/physiopathology , Stomatitis/physiopathology , Candidiasis, OralABSTRACT
35 ANUG patients were examined and compared clinically and demographically. Plaque removed from ulcerated sites in 20 patients was cultured using quantitative anaerobic procedures and examined by electron and darkfield microscopy. Patients were classified as having ANUG when presenting with ulceration and necrosis of interproximal papillae, pain and bleeding. The clinical symptoms of fetid odor, pseudomembrane formation, lymphadenopathy and elevated body temperature were present in 97%, 85%, 61% and 39% of the ANUG patients, respectively. 83% of the patients were smokers. The ANUG patients demonstrated a lower average age (24 years) than the general clinic population (32 years). There was a slightly higher % of male (54%) than female (46%) and the % of Caucasian (51%) and black (49%) ANUG patients were almost equal. Cultural studies revealed that gram-negative rods were the predominant cultivable micro-organisms present in the plaque, representing 78.2% of the total recoverable count. Of these, nearly half were strict anaerobes with Bacteroides gingivalis and Fusobacterium nucleatum accounting for 7.8% and 3.4%, respectively. Anaerobic and facultative gram-positive cocci (15.5%), gram-negative cocci (3.5%) and gram-positive rods (2.8%) were also isolated. Microscopic analysis of the morphologic composition of plaque revealed that rods (43%) constituted the greatest % of the total microorganisms observed followed by spirochetes (30%) and cocci (27%). 8 distinct types of spirochetal periplasmic flagellar arrangement were observed by electron microscopy, the "2-4-2" periplasmic flagellar arrangement being most numerous.
Subject(s)
Bacteria/isolation & purification , Dental Plaque/microbiology , Gingivitis, Necrotizing Ulcerative/microbiology , Acute Disease , Adult , Age Factors , Bacteria/classification , Bacteria/ultrastructure , Black People , Female , Gingivitis, Necrotizing Ulcerative/physiopathology , Humans , MaleABSTRACT
Discomfort manifesting in the gingival tissues prompts patients to seek emergency treatment. Several clinical entities should be included in the differential diagnosis. Accurate diagnosis and appropriate therapy is essential to resolving the problem.
Subject(s)
Periodontal Diseases/therapy , Emergencies , Gingival Diseases/etiology , Gingival Diseases/therapy , Gingivitis, Necrotizing Ulcerative/diagnosis , Gingivitis, Necrotizing Ulcerative/physiopathology , Gingivitis, Necrotizing Ulcerative/therapy , Humans , Periapical Abscess/diagnosis , Periapical Abscess/etiology , Periapical Abscess/physiopathology , Periapical Abscess/therapy , Periodontal Abscess/etiology , Periodontal Abscess/therapy , Periodontal Diseases/diagnosis , Periodontal Diseases/physiopathology , Postoperative Complications , Self Mutilation , Tooth Fractures/complications , Tooth Root/injuriesSubject(s)
Periodontitis/physiopathology , Adult , Aggressive Periodontitis/pathology , Aggressive Periodontitis/physiopathology , Child , Gingivitis, Necrotizing Ulcerative/pathology , Gingivitis, Necrotizing Ulcerative/physiopathology , Humans , Periodontitis/classification , Periodontitis/pathology , PubertyABSTRACT
The devastating orofacial gangrenous disease known as cancrum oris (noma) is still commonly seen in underprivileged Nigerian children. These children are usually victims of such stressors as chronic malnutrition, numerous endemic communicable diseases and severe adverse physical conditions which may lead to depletion of their adaptive resources or produce physiological maladaptation to additional stressors. Measles is the most common infection preceding the development of noma in Nigerian children. Acquired immunodeficiency as well as the impaired endocrine balance of the chronically malnourished permits, for example, widespread infection with the measles virus. Anergy resulting from the combination of malnutrition and measles virus infection promotes selective overgrowth and invasion by an infective consortium consisting of anaerobic organisms and other species capable of elaborating necessary growth factors for the former. Because of the pre-existing depletion of adaptive physiologic resources in the malnourished child, the infection is not readily contained locally as necrotizing ulcerative gingivitis but instead spreads rapidly to the next naturally occurring anatomical barriers. This is then followed by continuing necrosis and possible sequestration as exemplified by noma.