Etiology and types of necrotizing periodontal diseases


  • Yazeed Abdullah Abdullah King Abdullah Medical City for National Guard, Riyadh, Saudi Arabia
  • Abdulhameed G. Albeshr King Abdullah Medical City for National Guard, Riyadh, Saudi Arabia
  • Ala'a Abdulkalq Albasher Dental Department, King Faisal Hospital, Al Ahsa, Saudi Arabia
  • Abdullah Saeed Alassiri College of Dentistry, King Khalid University, Abha, Saudi Arabia
  • Mahmood Abdulaziz Shater Dental Department, East Jeddah Hospital, Jeddah, Saudi Arabia
  • Mohammed Ali Alqahtani Dental Department, West Riyadh Dental complex, Riyadh, Saudi Arabia
  • Khaled Taib Ageely Al-Jabal Primary Healthcare, Ministry of Health, Jazan, Saudi Arabia
  • Raghad Saeed Alshahrani College of Dentistry, King Khalid University, Abha, Saudi Arabia
  • Anas Abed Alkhormani Veneer Dental Center, Jeddah, Saudi Arabia
  • Alaa Mohammed Bawakid College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
  • Lamia S. A. Al Huwaity Dental Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
  • Rayan Ibrahim Albulushi College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia



Necrotizing periodontal diseases, Necrotizing gingivitis, Necrotizing periodontitis, Etiology, Microbiology, Classification, Pathophysiology


Necrotizing periodontal diseases pose a clinical significance because it has been associated with a severe prognosis that can cumulatively lead to rapid tissue destruction. A slow rate of destruction has been reported for patients with necrotizing periodontal diseases, and reports show that chronicity might be a characteristic in some patients, while many patients might also suffer from disease recurrence. The association of other oral lesions might also be a characteristic in some situations, which usually occurs in cases when systemic involvement is present. In the present literature review, we aim to discuss the etiology and types of necrotizing periodontal diseases based on evidence from the different related studies in the literature. Microbiology plays an important role in the pathogenesis of the condition, and some organisms as spirochetes were directly correlated with the etiology of the condition. Evidence also shows that the presence of the different risk factors might be the major contributor to the development of the condition as different risk factors were found to be directly correlated with the disease. Among the different factors, impacted host immune response and the presence of deteriorating systemic conditions have been widely reported in the literature as significant factors predisposing to developing the disease. Other factors as smoking and alcohol consumption, previous history of the disease, and other oral lesions, were also reported. Further research is needed for better classification of the condition and determination of more significant risk factors.


Parameter on acute periodontal diseases. American Academy of Periodontology. J periodontol. 2000;71(5):863-6.

Pindborg JJ. Influence of service in armed forces on incidence of gingivitis. J Am Dental Asso. 1951;42(5):517-22.

Johnson BD, Engel D. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. J periodontol. 1986;57(3):141-50.

MacCarthy D, Claffey N. Acute necrotizing ulcerative gingivitis is associated with attachment loss. J clin periodontol. 1991;18(10):776-9.

Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J periodontol. 2018;89(1):S85-102.

Lang N, Soskolne W, Greenstein G, et al. Consensus report: necrotizing periodontal diseases. Ann periodontol. 1999;4(1):78.

Rowland RW. Necrotizing ulcerative gingivitis. Ann periodontol. 1999;4(1):65-73.

Novak MJ. Necrotizing ulcerative periodontitis. Ann periodontol. 1999;4(1):74-8.

Feller L, Lemmer J. Necrotizing gingivitis as it relates to HIV infection: a review of the literature. Periodontal Practice Today. 2005;2:1.

Courtois GJ 3rd, Cobb CM, Killoy WJ. Acute necrotizing ulcerative gingivitis. A transmission electron microscope study. J periodontol. 1983;54(11):671-9.

Listgarten MA. Electron microscopic observations on the bacterial flora of acute necrotizing ulcerative gingivitis. J periodontol. 1965;36:328-39.

Loesche WJ, Syed SA, Laughon BE, Stoll J. The bacteriology of acute necrotizing ulcerative gingivitis. J periodontol. 1982;53(4):223-30.

Dewhirst FE, Tamer MA, Ericson RE. The diversity of periodontal spirochetes by 16S rRNA analysis. Oral microbiol immunol. 2000;15(3):196-202.

Riviere GR, Wagoner MA, Baker-Zander SA. Identification of spirochetes related to Treponema pallidum in necrotizing ulcerative gingivitis and chronic periodontitis. N Eng j med. 1991;325(8):539-43.

Riviere GR, Weisz KS, Simonson LG, Lukehart SA. Pathogen-related spirochetes identified within gingival tissue from patients with acute necrotizing ulcerative gingivitis. Infect immunity. 1991;59(8):2653-7.

Dufty JR. Report for the pathological committee of the war office of an inquiry into gingivitis and Vincent's disease occurring in the Army. J Royal Army Med Corps. 2014;160(1):i7-8.

Brown RH. Necrotizing ulcerative gingivitis in mongoloid and non-mongoloid retarded individuals. J periodontal res. 1973;8(5):290-95.

Akin L, Herford AS, Cicciù M. Oral presentation of disseminated histoplasmosis: a case report and literature review. J Oral Maxillofac Surg. 2011;69(2):535-41.

Nelken A, Basso M, Francetti L, Fabbro MD, Testori T, Weinstein RL. Necrotizing Periodontal Disease in a Patient with Leukocytoclastic Vasculitis. 2005.

Guvenc D, Gokbuget AY, Cintan S. An atypical form of necrotizing periodontitis. J periodontol. 2009;80(9):1548-53.

Radden BG, Reade PC. Acute gingivitis and dermatitis of scorbutic origin. Oral surg oral med oral pathol. 1963;16:236-45.

Gomes MF, Kohlemann KR, Plens G, Silva MM, Pontes EM, Da Rocha JC. Oral manifestations during chemotherapy for acute lymphoblastic leukemia: a case report. Quintessence int. 2005;36(4):307-13.

Enwonwu CO, Falkler WA, Jr., Phillips RS. Noma (cancrum oris). Lancet. 2006;368(9530):147-56.

Buchanan JA, Cedro M, Mirdin A, Joseph T, Porter SR, Hodgson TA. Necrotizing stomatitis in the developed world. Clin experimental dermatol. 2006;31(3):372-4.

Osuji OO. Necrotizing ulcerative gingivitis and cancrum oris (noma) in Ibadan, Nigeria. J periodontol. 1990;61(12):769-72.

Jiménez M, Baer PN. Necrotizing ulcerative gingivitis in children: a 9 year clinical study. J periodontol. 1975;46(12):715-20.

Melnick SL, Alvarez JO, Navia JM, Cogen RB, Roseman JM. A case-control study of plasma ascorbate and acute necrotizing ulcerative gingivitis. J dental res. 1988;67(5):855-60.

Enwonwu CO. Epidemiological and biochemical studies of necrotizing ulcerative gingivitis and noma (cancrum oris) in Nigerian children. Arch oral biol. 1972;17(9):1357-71.

Enwonwu CO, Falkler WA Jr, Idigbe EO. Pathogenesis of cancrum oris (noma): confounding interactions of malnutrition with infection. Am j trop med hygiene. 1999;60(2):223-32.

Maupin CC, Bell WB. The relationship of 17-hydroxycorticosteroid to acute necrotizing ulcerative gingivitis. J periodontol. 1975;46(12):721-2.

Taiwo JO. Oral hygiene status and necrotizing ulcerative gingivitis in Nigerian children. J periodontol. 1993;64(11):1071-4.

Horning GM, Cohen ME. Necrotizing ulcerative gingivitis, periodontitis, and stomatitis: clinical staging and predisposing factors. J periodontol. 1995;66(11):990-8.

Wilton JM, Ivanyi L, Lehner T. Cell-mediated immunity and humoral antibodies in acute ulcerative gingivitis. J periodontal res. 1971;6(1):9-16.

López R, Baelum V. Cannabis use and destructive periodontal diseases among adolescents. J clin periodontol. 2009;36(3):185-9.

Robinson PG, Sheiham A, Challacombe SJ, Wren MW, Zakrzewska JM. Gingival ulceration in HIV infection. A case series and case control study. J clin periodontol. 1998;25(3):260-7.

Shields WD. Acute necrotizing ulcerative gingivitis. A study of some of the contributing factors and their validity in an Army population. J periodontol. 1977;48(6):346-9.

Giddon DB, Zackin SJ, Goldhaber P. Acute necrotizing ulcerative gingivitis in college students. J Am Dental Asso. 1964;68:380-6.

Stevens AW Jr, Cogen RB, Cohen-Cole S, Freeman A. Demographic and clinical data associated with acute necrotizing ulcerative gingivitis in a dental school population (ANUG-demographic and clinical data). J clin periodontol. 1984;11(8):487-93.

Magan-Fernandez A, O'Valle F, Pozo E, Liebana J, Mesa F. Two cases of an atypical presentation of necrotizing stomatitis. J periodontal implant sci. 2015;45(6):252-6.

Skach M, Zabrodský S, Mrklas L. A study of the effect of age and season on the incidence of ulcerative gingivitis. J periodontal res. 1970;5(3):187-90.

Falkler WA Jr, Martin SA, Vincent JW, Tall BD, Nauman RK, Suzuki JB. A clinical, demographic and microbiologic study of ANUG patients in an urban dental school. J clin periodontol. 1987;14(6):307-14.

Malberger E. Acute infectious oral necrosis among young children in the Gambia, West-Africa. J periodontal res. 1967;2(2):154-62.

Barnes GP, Bowles WF 3rd, Carter HG. Acute necrotizing ulcerative gingivitis: a survey of 218 cases. J periodontol. 1973;44(1):35-42.

Sangani I, Watt E, Cross D. Necrotizing ulcerative gingivitis and the orthodontic patient: a case series. J orthodontics. 2013;40(1):77-80.

Flaitz CM, Agostini F. Gingival disease associated with a decorative crown. Pediatr dentistry. 2002;24(1):47-9.

Giddon DB, Clark RE, Varni JG. Apparent digital vasomotor hypotonicity in the remission stage of acute necrotizing ulcerative gingivitis. J dental res. 1969;48(3):431-8.

Nicol AD, Muir KF, Harkness RA, MacPhee IT. Erythrocyte catalase activity in human ulceromembranous gingivitis. Arch oral biol. 1971;16(1):21-8.

Melnick SL, Go RC, Cogen RB, Roseman JM. Allelic variants for complement factors C3, C4, and B in acute necrotizing ulcerative gingivitis. J dental res. 1988;67(5):851-4.

Clark RE, Giddon DB. Body geometry of patients who had recurrent attacks of acute necrotizing ulcerative gingivitis. Arch oral biol. 1971;16(2):205-13.

Tkacz K, Gill J, McLernon M. Necrotising periodontal diseases and alcohol misuse-a cause of osteonecrosis? Bri dental j. 2021;231(4):225-31.




How to Cite

Abdullah, Y. A., Albeshr, A. G., Albasher, A. A., Alassiri, A. S., Shater, M. A., Alqahtani, M. A., Ageely, K. T., Alshahrani, R. S., Alkhormani, A. A., Bawakid, A. M., Huwaity, L. S. A. A., & Albulushi, R. I. (2021). Etiology and types of necrotizing periodontal diseases. International Journal Of Community Medicine And Public Health, 8(12), 6137–6142.



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