Acute necrotizing ulcerative gingivitis. A transmission electron microscope study

The purpose of this study was to provide additional evidence that in the lesions of acute necrotizing ulcerative gingivitis (ANUG), spirochetes and other microorganisms are capable of invading the nonnecrotic lamina propria of affected gingivae. Biopsies from eight patients with pathognomonic signs of ANUG were obtained under local anesthesia and processed for light and transmission electron microscopy. The results indicated that spirochetes and other bacteria are capable of penetrating the viable connective tissues of the lamina propria. The four zones of the ANUG lesion as first described by Listgarten were observed without difficulty. The maximum depth of bacterial infiltration into the lamina propria ranged from 155 to 400 microns from the nearest epithelial basal lamina. The histologic picture of the ANUG lesion did not always conform to the acute clinical manifestations.