1. ANUG
   1. Clinical Findings
      1. Also called Vincents disease, trench mouth & fusospirochaetal infection
      2. Punched out, crater like depressions at the crest of interdental papilla
      3. Necrosis of Interdental papilla or Marginal gingiva
      4. Metallic taste, pasty saliva, fever, fetid odour, Body pain ( Malaise)
      5. No pockets found
      6. Ulcers are covered by grey, pseudomembranous slough, have pronounced linear erythema
   2. Classification
      1. Pindborg classification
         1. Stage 1: only tip of Interdental papilla
         2. Stage 2: Extends to marginal gingiva
         3. Stage 3: Extends to attached gingiva
         4. Stage 4: Exposure of Bone
      2. Horning & Cohen classification
         1. Stage 1 : Necrosis of Tip of Interdental papilla
            1. NUG
         2. Stage 2: Necrosis of Entire Interdental papilla
            1. NUG/ NUP
         3. Stage 3: Necrosis of Marginal gingiva
            1. NUP
         4. Stage 4: Necrosis of Attached gingiva
            1. NUP
         5. Stage 5: Necrosis Extending to Buccal or Labial mucosa
            1. Necrotising stomatitis
         6. Stage 6: Necrosis Exposing Alveolar Bone
            1. Necrotising stomatitis
         7. Stage 7: Necrosis cheek & Skin
            1. Noma or Cancrum oris
   3. Zones of ANUG
      1. Lisgarten (4 zones of ANUG)
         1. Zone 1: Bacterial zone
         2. Zone 2: Neutrophil rich zone
         3. Zone 3: Necrotic zone
         4. Zone 4: zone of spirochete Infiltration
   4. D/d of ANUG
      1. 1) NUG: Primary Herpetic gingivostomatitis Desquamative gingivitis Chronic periodontitis Diptheria Syphilis
      2. 2) NUG is not contagious & ANUG is contagious
      3. 3) NUG is a painful condition
      4. 4) Pseudomembrane formation in NUG, Diptheria & Syphilis It’s easy to remove in NUG, but difficult in case of diptheria & syphilis
   5. T/t of ANUG
      1. Debridement
      2. Rinsis ( Hydrogen peroxide 1.5%+ 0.12% chlorhexidine)
      3. Improved oral Hygiene
      4. Oral Antibiotic
         1. Amoxicillin + Metronidazole
         2. Erythromycin 250 mg every 6 hr
         3. Tetracyclin 250 mg every 6 hr
      5. Surgical procedure
         1. Gingivoplasty
2. Primary Herpetic gingivostomatitis
   1. Infection caused by HSV-1
   2. Occurs most often in infants & children younger than 6 years
   3. In most cases , the primary infection is asymptomatic
      1. Part of primary infection remains latent in neuronal ganglia that innervate the site
   4. Secondary manifestations result from stimuli like sunlight, trauma, fever, & stress
   5. Secondary Manifestations include herpes labialis, herpetic stomatitis, herpes genitalis, ocular herpes & herpetic encephalitis
   6. Oral signs
      1. Initial stage : Characterized by presence of discrete, spherical gray vesicles, which may occur on the gingiva, labial & buccal mucosae, soft palate, pharynx, sublingual mucosa & tongue
      2. After 24 hours vesicles rupture & form painful, small ulcers with a red , elevated, halolike margin & a depressed yellowish or grayish white central portion
      3. Course of disease is 7-10 days, Scarring does not occur
   7. Oral symptoms
      1. Disease accompanied by generalised Soreness of Mouth
      2. Interferes with eating, drinking & Oral hygiene.
   8. Extraoral & Systemic signs & Symptoms
      1. Cervical adenitis, fever as high as 101 to 105 degree fahrenheit
3. Pericorinitis
   1. Pericoronitis is an intraoral inflammatory process due to infection of the gingival tissue surrounding or overlying an erupting or partially erupted tooth
   2. T/t of pericorinitis 1. Gentle flushing with warm water to remove debris & exudate 2. Swabbing with antiseptic after elevating the flap gently from the tooth with a scaler 3. Antibiotics in severe cases 4. If the flap is swollen & fluctuant , an incision may be necessary to establish drainage 5. After inflammation subsides, tooth should be extracted
4. Gingival Enlargement
   1. Due to Inflammation
      1. BOP seen & is painless
      2. Acute & chronic
   2. Drug Induced Gingival Enlargement
      1. C/F : 1) No tendency to Bleed 2) Painless 3) Interdental papilla + Marginal gingiva involved 4) Mulberry shape, pale pink, Resilient 5) Acanthosis of epithelium 6) Rete pegs are elongated
      2. Caused due to
         1. Phenytoin
            1. 50% shows gingival enlargement
            2. Does not bleed but due to enlargement & compounded by inflammation can start bleeding
         2. Ca channel blockers( Nifedipine, Amlodipine)
         3. Cyclosporins
            1. Prevalance is 30%
            2. Bleeds profusely , bcoz of increased plasma cells
   3. Dignosis of Gingival Enlargements
      1. Grade 0 - No sign of GE
      2. Grade 1 - Interdental papilla
      3. Grade II - papilla + Marginal gingiva
      4. Grade III - 3/4 th or more of the crown
   4. Conditioned Gingival Enlargement
      1. Most common initiating factor is Bacterial Plaque
      2. 1) Pregnancy gingivitis
         1. Starts by 3rd month Increases upto 8th month decrease in 9th month
         2. Spontaneous bleeding seen
         3. GE in pregnancy histopathologically k/s Angiogranuloma
         4. Two type of enlargement
            1. Type 1 a. Changes in vascular permeability b. Increased Edema c. Increased Prevotella Intermedia d. Generalised e. Interproximal areas
            2. Type 2: Tumor like enlargement a. Appears after 3rd month of pregnancy b. Discrete mushroom like, flattened spherical mass that protrudes from gingival margin c. Dusky red/ Magenta d. Painless
      3. 2) Puberty gingivitis
         1. Increased Capnocytophaga Increased tendency to bleed
      4. 3) plasma cell gingivitis
      5. 4) Vit C deficiency
   5. Idiopathic Gingival Enlargement
      1. Involves Interdental papilla + Marginal gingiva + attached gingiva
      2. Leathery in consistency Minutely pebelled Rete pegs are elongated High Recurrence rate
   6. Non Conditioned Gingival Enlargement
      1. Pyogenic granuloma Exaggerated tumor like growth on gingiva , can be conditioned response to minor trauma
   7. Systemic disease
      1. 1. Wegners granulomatosis
      2. 2. Sarcoidosis
      3. 3. Leukemia
         1. Acute monocytic Leukemia (AML)
         2. Acute Leukemia
   8. Tumors
      1. Benign
      2. Malignant
5. GINGIVITIS
   1. Classification by Peg & Schroeder
      1. Stage 1
         1. Initial (2-4 days)
         2. Increased GCF flow
         3. Vascular dilation
         4. Infiltration by PMNs
         5. PMNs
         6. Perivascular loss
      2. Stage II
         1. Early (4-7 days)
         2. Erythema & BOP
         3. Vascular Proliferation
         4. Rete pegs & Atrophic areas + stage II
         5. Lymphocytes
         6. Increased loss around infiltrate
      3. Stage III
         1. Established (14-21 days)
         2. Changes in color, size & Texture Plasma cell predominate
         3. Vascular Proliferation plus Blood stasis
         4. Advanced stage II
         5. Plasma cells
         6. Continued loss
      4. Stage IV
         1. Advanced (>21 days)
         2. Extension of the lesion into alveolar bone
         3. -
         4. -
         5. -
   2. McCall’s festoon
      1. Life Saver like gingival prominence
      2. Mostly seen in canine & Premolar facial surface
   3. Stillman Cleft
      1. Comma( , ) shaped indentation , which extends along the gingival margin into root surface due to inflammation