2019 Nug
2019 Nug
2019 Nug
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Fig 3. Clinical appearance at the third appointment. Fig 4. Clinical appearance at the fourth appointment.
Fig 5. Radiographic evaluation at the fourth appointment, revealing no interproximal bone loss.
behavior and compliance with the periodontal treatment. The Pelotas, Pelotas, Brazil. His main concerns were gingival bleed-
objective of the present case report is to describe the success- ing when toothbrushing and pronounced halitosis that caused
ful clinical treatment of a patient with NUG over a period of him embarrassment.
10 years of maintenance.
Clinical findings and diagnostic assessment
Case report Clinical examination revealed necrosis and ulceration of the
Patient information interdental papilla, which were covered by a grayish slough
An 18-year-old man with leukoderma was referred for treat- (pseudomembrane). The papilla did not fill the entire interproxi-
ment to the School of Dentistry at Federal University of mal space in some sites, and generalized, extensive accumulation
agd.org/generaldentistry 63
Clinical treatment of necrotizing ulcerative gingivitis: a case report with 10-year follow-up
A B
C D E
Fig 6. Clinical appearance during periodontal maintenance therapy. A. Six-month follow-up. B. One-year follow-up. C. Two-
year follow-up. D & E. Ten-year follow-up.
of oral biofilm was observed on the dental surfaces (Fig 1). The of educational and motivational intervention began with the
teeth were well positioned in the arch. Radiographic examina- presentation of detailed information—through illustrative pho-
tion was not performed at the first evaluation due to the condi- tographs and pamphlets—to the patient at each session. The
tion of the soft tissue. educational materials emphasized the signs and symptoms of
During the physical examination, no systemic condition was the disease and their relationship to the presence of bacterial
found that could predispose the patient to NUG. However, the biofilm. The patient was also instructed to be aware of the signs,
patient’s parents reported that he had been experiencing severe symptoms, and locations of periodontal disease.
stress as well as psychological pressure at school due to a period Detailed information about the importance of efficient daily
of academic probation. Based on the clinical data obtained at the oral hygiene was followed by demonstration of oral hygiene
examination, NUG was diagnosed. protocols on a model—using a toothbrush technique appro-
priate for the patient’s specific clinical condition—as well as
Therapeutic interventions detailed, precise instruction in the use of dental floss. At each
At the second appointment, 7 days after the evaluation and diag- clinical session, a dye solution that stains plaque was used as an
nosis, the initial clinical treatment involved the careful removal educational tool to demonstrate the location of bacterial plaque.
of the supragingival plaque, aided by topical anesthetics (Fig Plaque-disclosing tablets were given to the patient for weekly
2). The patient was instructed to perform extensive atraumatic home use.
and careful oral hygiene procedures and to rinse with a 0.12% Periodontal clinical control was guided by the patient’s adher-
chlorhexidine gluconate mouthwash twice a day for 30 days. ence to the recall system of weekly follow-up appointments
At the third appointment, 7 days later, supragingival scaling throughout treatment, monthly follow-up for the first 6 months
was performed along with supervised brushing and reinforce- posttreatment, and follow-up 2-3 times a year during periodon-
ment of the oral hygiene instructions (Fig 3). tal mainenance therapy; at each visit, the needed frequency of
At the fourth appointment, 7 days after the third, subgingival attendance was assessed. The findings at multiple follow-up
scaling was performed on specific sites. Supragingival scaling, examinations showed that periodontal health and function were
planing, and polishing of the tooth surfaces were also performed successfully reestablished and maintained over time (Fig 6).
along with reinforcement of the oral hygiene instructions (Fig 4). Clinical and radiographic examinations revealed healthy tissues
A radiographic examination was performed, and no bone loss and no evidence of progressive periodontal attachment loss.
was detected (Fig 5). Impressions of the maxillary and mandibu-
lar arches were taken for future rehabilitation planning. Discussion
A motivational approach to changing the patient’s oral Necrotizing ulcerative gingivitis is restricted to the gingival
hygiene behavior was emphasized by the clinical team from the tissue without the involvement of other tissues of the peri-
first evaluation. With regular and effective maintenance of oral odontium. Progression of this disease involves the attachment
hygiene habits by the patient, the inflammatory clinical condi- apparatus with consequent tissue loss.4 Nonetheless, case
tion was reversed, and periodontal health was observed within a reports have emphasized that conservative local treatment of
few weeks. NUG without systemic involvement can produce good out-
After the completion of the cause-related therapy phase, comes. According to this premise, therapies are based on local
the patient was enrolled in a periodontal maintenance pro- debridement and scaling and root planing sessions together with
gram to optimize the therapeutic interventions. The process good plaque control through a strict oral hygiene regimen; local
agd.org/generaldentistry 65
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