Necotizing gingivostomatitis: NUG to noma

Necrotizing gingivostomatitis (NG) is an increasingly rare but potentially serious infection that can present as a spectrum of clinical disease ranging from necrotizing ulcerative gingivitis to noma. The diagnostic triad for NG is pain, interdental ulceration, and gingival bleeding, but many cases also display fetid breath and pseudomembrane formation. Etiology is believed to be an opportunistic bacterial infection occurring in individuals debilitated by malnutrition, human immunodeficiency virus infection, or other systemic factors, including inadequate sleep, unusual stress, recent illness, alcohol use, and smoking. Treatment for NG includes bacterial control by strict oral hygiene, antiseptic rinses, antibiotic use in selected cases, and correction of predisposing factors. In compliant patients, gingivectomy or gingival grafting may be indicated after initial healing to resolve any residual defects.