Necrotizing Gingivitis as it Relates to HIV Infection: A Review of the Literature

In this paper the terms necrotizing gingivitis (NG) and necrotizing periodontitis (NP) will be used in preference to the customary terms necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative periodontitis (NUP) which in our opinion are inappropriate because in NG, ulceration is not a primary feature, but is secondary to necrosis of the gingival margins; and in NP, the necrotizing disease by definition is in the attachment apparatus where the term ulceration is not applicable. NG is characterized by marginal gingival necrosis starting at the interdental papillae with gingival bleeding and pain. The breath may be foetid and there may be pseudomembrane formation and lymphodenopathy but these features are not invariable (American Academy of Periodontology, 1999; Barens et al, 1973; Falker et al, 1987; Horning and Cohen, 1995; Johnson and Engel, 1986; Kinane, 2001; Muryama et al 1994; Rowland, 1999). Necrotizing periodontitis (NP) is an extension of NG into the periodontal attachment apparatus, being commonly observed in debilitated subjects with predisposing conditions including, but not limited to severe malnutrition (Enwonwu, 1972; Jenkins and Papapanou, 2001; Novak, 1999; Osuji, 1990; Taiwo, 1993) and immuno-suppression (Cogen et al, 1983; Glick et al, 1994).