Necrotizing Periodontal Diseases

Patients falling under this category present with three typical clinical features: necrosis of the papilla, bleeding; and pain. This condition is associated with an impairment of the host immune response.15 Table 6 illustrates the key features of this classification.

Photo showing necrotizing periodontal diseases
Image Courtesy of Dr. C. Cobb.
Table 6. Classification of Necrotizing Periodontal Diseases.
Patient Category of Necrotizing Periodontal Disease Patients Predisposing Conditions Clinical Condition
Severely & Chronically Compromised Adult - HIV+/AIDS with CD4 counts <200 & detectable viral load
- Other severe systemic conditions that cause immunosuppression
Necrotizing Gingivitis (NG)
Necrotizing Periodontitis (NP)
Necrotizing Stomatitis (NS)
Possible progression
Child - Severe malnourishments
- Extreme living conditions
- Severe viral infections
Temporarily or Moderately Compromised Gingivitis Patient

Periodontitis Patient
- Uncontrolled factors: stress, nutrition, smoking, habits
- Previous NPD (residual craters)
Generalized NG
Possible progression to NP
Local Factors: root proximity, tooth malposition Localized NG
Possible progression to NP
Common Predisposing Factors NG Infrequent Progression
NP infrequent progression
Adapted from Papapanou et al. 2018.15