Necrotizing Periodontal Diseases

Excerpt

Necrotizing periodontal diseases (NPDs) encompass necrotizing gingivitis, necrotizing periodontitis, and necrotizing stomatitis. In severe cases, NPDs may progress to noma (cancrum oris). These conditions represent stages of a single pathological process, sharing a common etiology and clinical profile. Characteristic features include pain, gingival necrosis, interdental ulceration, and, in advanced stages, osteonecrosis.

Necrotizing gingivitis constitutes the most common and earliest manifestation, typically affecting immunosuppressed individuals. Necrosis is confined to the interdental papillae, which exhibit the classic punched-out morphology. The condition remains reversible with appropriate therapy while attachment loss has not yet occurred. However, without treatment, the disease may advance rapidly, causing periodontal attachment loss, pseudomembrane formation, and systemic signs such as fever and lymphadenopathy—features consistent with necrotizing periodontitis.

Further extension into the alveolar bone with osteonecrosis and sequestration defines necrotizing stomatitis. The most severe presentation, noma, involves fulminant, noncontagious orofacial gangrene, primarily affecting severely malnourished individuals in low-resource settings. Noma rapidly destroys facial soft and hard tissues and carries a high risk of mortality (see Image. Noma).