Clinical diagnosis and treatment of necrotizing ulcerative gingivitis in the orthodontic patient. A case report.

Jesús Israel Rodríguez-Pulido, Nancy Quiroga-Zúñiga, Gloria Martínez-Sandoval


Introduction: About 0.1% of the population suffers from necrotizing ulcerative gingivitis, a disease of rapid progression and acute manifestation, which may progress to necrotizing ulcerative periodontitis and eventually to bone sequestration and loss of gingival tissue. Case report: A 21-year-old female patient undergoing orthodontic treatment for six months, diagnosed with necrotizing ulcerative gingivitis due to acute pain in the gingival tissue, spontaneous bleeding, halitosis and abundant plaque. The treatment was conservative and effective, obtaining total remission of the lesion after seven days and three months of postoperative follow-up. Conclusion: Today there are no epidemiological or clinical reports that support the relationship of necrotizing ulcerative gingivitis and orthodontic treatment. Prevention is critical to the success of the treatment, which is why the dentist should recognize the clinical features of necrotizing ulcerative gingivitis to raise awareness of its risks in the orthodontic patient.



Gingivitis; Necrotizing ulcerative gingivitis; Hydrogen peroxide; Orthodontics.


Campbell CM, Stout BM, Deas DE. Necrotizing ulcerative gingivitis: a discussion of four dissimilar presentations. Tex Dent J. 2011;128(10):1041–51.

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.

Choque VL. Gingivitis ulceronecrotizante aguda. Rev Act Clin Med. 2010;1(1):46–52.

Lira DP, Zerón A. Gingivitis ulcerativa necrotizante Revisión y reporte de dos casos. Rev Mex Periodontol. 2012;4(1):7–14.

Chan Y, Ma AP, Lacap-Bugler DC, Huo YB, Keung Leung W, Leung FC, Watt RM. Complete Genome Sequence for Treponema sp. OMZ 838 (ATCC 700772, DSM 16789), Isolated from a Necrotizing Ulcerative Gingivitis Lesion. Genome Announc. 2014;2(6):1-2.

Bolivar I, Whiteson K, Stadelmann B, Baratti-Mayer D, Gizard Y, Mombelli A, Pittet D, Schrenzel J, Geneva Study Group on Noma (GESNOMA). Bacterial Diversity in Oral Samples of Children in Niger with Acute Noma, Acute Necrotizing Gingivitis, and Healthy Controls. PLoS Negl Trop Dis. 2012;6(3):e1556.

Herrera D, Alonso B, Arriba L, Santa Cruz I, Serrano C, Sanz M. Acute periodontal lesions. Periodontol 2000. 2014;65(1):149–77.

Ramos MP, Ferreira SM, Silva-Boghossian CM, Souto R, Colombo AP, Noce CW, Gonçalves LS. Necrotizing periodontal diseases in HIV-infected Brazilian patients: a clinical and microbiologic descriptive study. Quintessence Int. 2012;43(1):71–82.

Lanza DG. Tratamiento odontológico integral del paciente oncológico: Parte II. Odontoestomatol. 2013;15(22):46–63.

Ryder MI, Nittayananta W, Coogan M, Greenspan D, Greenspan JS. Periodontal disease in HIV/AIDS. Periodontol 2000. 2012;60(1):78–97.

Maloney WJ, Weinberg MA. Implementation of the American Society of Anesthesiologists Physical Status Classification System in Periodontal Practice. J Periodontol. 2008;79(7):1124–6.

Samet N, Jotkowitz A. Classification and prognosis evaluation of individual teeth – A comprehensive approach. Quintessence Int. 2009;40(5):377-387.

Rathore N, Desai A, Trehan M, Jharwal V, Puzhankara L, Marya A. Ortho-Perio Interrelationship. Treatment Challenges. N Y State Dent J. 2015;81(5):42–7.

Karkhanechi M, Chow D, Sipkin J, Sherman D, Boylan RJ, Norman RG, Craig RG, Cisneros GJ. Periodontal status of adult patients treated with fixed buccal appliances and removable aligners over one year of active orthodontic therapy. Angle Orthod. 2013;83(1):146–51.

Moosa Y, Han LN, Safdar J, Sheikh OA, Pan YP. Periodontal status of Pakistani orthodontic patients. Braz Oral Res. 2015;29(1):1-5.

Boke F, Gazioglu C, Akkaya S, Akkaya M. Relationship between orthodontic treatment and gingival health: A retrospective study. Eur J Dent. 2014;8(3):373–80.

Nassar PO, Bombardelli CG, Walker CS, Neves KV, Tonet K, Nishi RN, Bombonatti R, Nassar CA. Periodontal evaluation of different toothbrushing techniques in patients with fixed orthodontic appliances. Dent Press J Orthod. 2013;18(1):76–80.

Coslet JG, Vanarsdall R, Weisgold A. Diagnosis and classification of delayed passive eruption of the dentogingival junction in the adult. Alpha Omegan. 1977;70(3):24–8.

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

Quirynen M, Teughels W, de Soete M, van Steenberghe D. Topical antiseptics and antibiotics in the initial therapy of chronic adult periodontitis: microbiological aspects. Periodontol 2000. 2002;28(1):72-90.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Corresponding: Facultad de Odontología, Universidad de Concepción, Chile. Roosevelt 1550, Concepción, Chile. Phone +56-41-2204232 - E-mail