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Necrotizing Periodontitis

Acute necrotic destruction of periodontal tissues, often associated with immune deficiency

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ağız ve Diş Sağlığı department. Book Appointment →

What is Necrotizing Periodontitis?

Necrotizing periodontitis (NP) is the necrotizing form of periodontal diseases and may extend from gingiva to alveolar bone destruction (necrotizing stomatitis). The major etiologic role of fusiform bacilli, Treponema spp. and Prevotella intermedia mixed flora is well established. The 2017 World Workshop classified the disease into three stages: necrotizing gingivitis (limited to soft tissue), necrotizing periodontitis (with alveolar bone destruction), and necrotizing stomatitis (mucosal extension).

It typically affects young adults; immunocompromised individuals (HIV/AIDS, leukemia, malnutrition), heavy smokers, those with poor oral hygiene, and patients under stress are at risk. Pathognomonic features are necrotic punched-out lesions of the interdental papillae, profuse pain, bleeding, and a typical halitosis ('fetor oris').

Treatment is multistep: mechanical debridement, antimicrobial mouthwash (chlorhexidine, hydrogen peroxide), systemic metronidazole + amoxicillin in selected cases. Underlying systemic factors (HIV, diabetes, nutrition) must be evaluated.

Symptoms

Severe gingival pain (sudden onset)
Necrosis with punched-out ulcers of the interdental papillae
Spontaneous gingival bleeding
Severe halitosis (fetor oris)
Pseudomembranous gray-yellow membrane
Lymphadenopathy and fever (severe cases)

Risk Factors

HIV/AIDS and immunosuppression
Severe malnutrition
Heavy smoking
Poor oral hygiene
Severe stress and depression
Malignancies (leukemia, lymphoma)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden onset severe gum pain
  • Spontaneous bleeding and necrosis
  • Severe foul mouth odor
  • Fever and lymphadenopathy
  • Recurrent gingival ulcerations (immunodeficiency suspicion)

Treatment Methods

01
Initial mechanical debridement (under local anesthesia)
02
Chlorhexidine 0.12% mouthwash
03
Hydrogen peroxide irrigation
04
Metronidazole 500 mg 3x/day + amoxicillin 500 mg 3x/day (7 days)
05
Pain control (NSAID, paracetamol)
06
Investigation of systemic causes (HIV test, CBC)

Which Department to Visit?

You can visit our Ağız ve Diş Sağlığı department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Ağız ve Diş Sağlığı Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.