Necrotizing ulcerative periodontitis (NUP) may be an extension of necrotizing ulcerative gingivitis (NUG) into the periodontal structures, leading to periodontal attachment and bone loss.

areas of ulceration and necrosis of the interdental papilla covered by a whitish yellow soft layer, or pseudomembrane, and surrounded by an erythematous halo. Lesions are typically painful and bleed easily, often without provocation.

Patients may also present with oral malodor, localized lymphadenopathy, fever, and malaise.

Microscopically, NUG lesions demonstrate a nonspecific necrotizing inflammation that presents with a predominant polymorphonuclear leukocyte infiltrate in the ulcerated areas and an abundant chronic infiltrate of lymphocytes and plasma cells in the peripheral and deeper areas.

necrotizing ulcerative periodontitis” 1989 World Workshop in Clinical

Periodontics.  “necrotizing ulcerative gingivoperiodontitis 1999 subclassifications of NUG and NUP-

necrotizing ulcerative periodontal diseases

necrosis and ulceration of the coronal portion of the interdental papillae and gingival margin, with a painful, bright red marginal gingiva that bleeds easily.

distinguishing feature of NUP - destructive progression of the disease that includes periodontal attachment and bone loss.

Deep interdental osseous craters typify periodontal lesions of NUP

“conventional” periodontal pockets with deep probing depth are not found

Advanced lesions of NUP - severe bone loss, tooth mobility, and ultimately tooth loss.

NUP patients may present with oral malodor, fever, malaise, or lymphadenopathy.

Linear gingival erythema (LGE), NUG, and NUP are the most common HIV-associated periodontal conditions 

Necrotizing forms of periodontitis appear to be more prevalent in patients with more severe immunosuppression

mixed fusiform-spirochete bacterial flora appears to play a key role.

predisposing factors – poor oral hygiene, preexisting periodontal disease, smoking, viral infections immunocompromised status, psychosocial stress, and malnutrition.

NUP is frequently associated with a diagnosis of AIDS or a positive HIV status.

treatment -local debridement, local antiplaque agents, and systemic antibiotics.

Early diagnosis and treatment of NUP are crucial

Candida albicans   Actinobacillus (Aggregatibacter)

actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Fusobacterium

nucleatum, and Campylobacter species

NUG and NUP lesions are more prevalent in patients with compromised or suppressed immune systems

a compromised immune system -impaired T-cell function and altered T-cell ratios,

compromised immunity predispose individuals to NUG and NUP as well.

stress increases systemic cortisol levels, and sustained increases in cortisone have a suppressive effect on the immune response.

malnutrition, particularly when extreme, contributes to a diminished host resistance to infection and necrotizing disease.

Depletion of nutrients to cells and tissues results in immunosuppression and increases disease susceptibility