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Necrotizing periodontal diseases

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Necrotizing ulcerating gingivitis (NUG)

While necrotizing ulcerating gingivitis (NUG) was classified as gingivitis on account of the absence of loss of attachment and necrotizing ulcerating periodontitis (NUP) as periodontitis because of the associated loss of attachment in earlier classifications of periodontal diseases, the 1999 classification has a separate group for necrotizing diseases.
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Necrotizing ulcerating gingivitis is an extremely painful infectious disease. It occurs mainly in the interdental and marginal gingiva. NUG is an acute disease and can be treated well by debridement in combination with antibiotic therapy.

Clinical signs:
  • Interdental necrosis
  • Ulcerative papillae
  • Bleeding
  • Pain
  • Usually no loss of attachment
  • Acute stress
  • Smoking
  • Existing gingivitis
  • Immunosuppression, in particular
(Rowland 1999; Carranza et al. 2006)

Necrotizing ulcerating periodontitis (NUP)

Necrotizing ulcerating periodontitis is deliberately separate from the periodontitis group in the 1999 classification because there is no microbiological or immunological evidence that similar pathologic processes take place in this necrotizing periodontitis to those in other forms of periodontitis (Novak 1999).

The clinical symptoms correspond to those of NUG. However, clinical loss of attachment with bone loss occurs in addition. HIV patients in particular are affected by the disease.


  • Carranza, Fermin A.; Newman, Michael G.; Takei, Henry H.; Klokkevold, Perry R. (2006): Carranza's clinical periodontology. 10th ed. St. Louis, Mo.: Saunders Elsevier
  • Novak, M. J. (1999): Necrotizing ulcerative periodontitis. In: Ann. Periodontol. 4 (1), S. 74–78. DOI: 10.1902/annals.1999.4.1.74
  • Rowland, R. W. (1999): Necrotizing ulcerative gingivitis. In: Ann. Periodontol. 4 (1), S. 65-73; discussion 78. DOI: 10.1902/annals.1999.4.1.65