The Bacteriology of Acute Necrotizing Ulcerative Gingivitis

Abstract

Plaque samples from 22 ulcerated sites in eight patients with ANUG were cultured using quantitative anaerobic procedures and were examined microscopically. The partial characterization of the predominant cultivable flora revealed a constant flora comprised of a limited number of bacterial types and a variable flora composed of a heterogeneous array of bacterial types. This constant flora would appear to be pathognomonic of acute necrotizing ulcerative gingivitis (ANUG) and included the various Treponema and Selenomonas sp., which comprised about 32 and 6%, respectively, of the microscopic count; B. melaninogenicus ssp. intermedius and Fusobacterium sp., which averaged 24 and 3%, respectively, of the viable count. One week of metronidazole treatment caused a prompt resolution of clinical symptoms, which coincided with a significant reduction in the plaque proportions of the Treponema sp., B. melaninogenicus ssp., intermedius and Fusobacterium sp. for at least 2 to 3 months following treatment. Thus, the same anaerobic species which were numerically associated with the ANUG lesion were also selectively reduced in the plaque flora following resolution of the infection. This supports a role for the above species in the ulcerative stage of the lesion but does not demonstrate that these specific anaerobes initiated the infection. although not confirmed by the data, it was proposed that these particular anaerobic species gained ascendency in the plaque as a result of being selected through the availability of host-derived nutrients in individuals who had undergone certain physiological and psychological stresses.

Incidence of Prevotella intermedia and Prevotella nigrescens in Periodontal Health and Disease

“…P. intermedia has been commonly isolated from not only subgingival sites in adults suffering from periodontitis and various types of gingivitis, such as pregnancy gingivitis, acute necrotizing gingivitis and HIV-related gingivitis (10,13,19) but also from subgingival plaques of periodontally healthy subjects.…”

“…Porphyromonas gingivalis is well known as a putative etiologic pathogen in the progression of periodontal disease, because this bacterium particularly has been associated with periodontally active diseased sites and loss of periodontal attachment (23,25,30), while black-pigmented Prevotella intermedia has been found in both periodontally diseased patients and healthy subjects (4,9,15,27,33). P. intermedia has also been reported to be associated with periapical abscess (7), pregnancy gingivitis (10), acute necrotizing ulcerative gingivitis (13) and HIV associated periodontal lesions (19). It has been suggested that P intermedia includes several biochemical, serological, and genotypical variants (1, 2, 5, 6).…”

Synergy in biofilm formation between Fusobacterium nucleatum and Prevotella species

“…Fusobacterium species including F. nucleatum, are detected in high frequency in lesions of gingivitis and chronic periodontitis (8,9). P. intermedia and Prevotella nigrescens are frequently isolated from the periodontal lesions of patients with chronic periodontitis (8,9,10), aggressive periodontitis (11,12), puberty-associated gingivitis (13,14), and acute necrotizing ulcerative gingivitis (15). Recently, our research group reported that the average number of periodontopathic bacterial species, including P. intermedia and P. nigrescens, was significantly higher in plaque samples 5 harboring F. nucleatum and/or F. periodontium than in those without in Japanese children and mothers (16).…”

Noma management in a child with systemic lupus erythematosus

“…Increased steroid levels in the mouth could also serve as a rich nutrient source for anaerobes. 24 Thus, the patient has high risk for developing secondary infection such as noma.…”