ULCERATIVE GINGIVITIS 174^ 



Ulcerative Gingivitis. 

 Synonym. — Mai de Bocha. 



This was studied by Miller, an American dental surgeon, in 1882, 

 who first saw the spiroch^etes and the fusiform organisms which 

 were subsequently described by Vincent, in 1898, as the causal agent 

 of a membrano-ulcerative pharyngitis and tonsillitis, a membrano- 

 ulcerative stomatitis, and a membrano-ulcerative gingivitis, two of 

 which are commonly present when a case comes to be noted, 

 although the gingivitis is nearly always the primal disease. 



All forms are common in the tropics, and their relative frequency 

 has been investigated in Palestine by Schimeoni-Meckler, in 1917, 

 who found that 78 cases of mouth disease could be resolved into 

 28 cases of ulcerative gingivitis, 17 of ulcerative stomatitis, 6 of 

 Vincent's angina, and 27 of mixed types. Thewhole subject has been 

 ably studied by Barlow in 1914, Bowman in 1916, by Taylor and 

 McKinsty in 1917, and by Colyer in 1918. There are three varieties 

 of the complaint — viz., the acute, the subacute, and the chronic. 



Acute Variety. — This is an acute inflammation of the margins 

 of the gums, of gradual onset, but which spreads rapidly and causes 

 ulceration of the interdental papillae and sloughing of the gums 

 around the necks of the teeth, and in severe cases ulceration of the 

 oral mucosa, associated with malaise, fever, and enlargement of the 

 lymph glands, haemorrhage from the gums, and pain therein, 

 especially at night, bad taste in the mouth, offensive breath, difficult 

 and painful mastication, and loose and tender teeth. There is 

 oedema of "fhe interdental papillae, which are bluish-red in colour or 

 covered with a brownish friable slough. It usually attacks the 

 gums around the upper incisor teeth, but may begin anywhere where 

 food tends to accumulate. It spreads from person to person, but is 

 commonly met with in persons living under bad conditions. 



Subacute Variety. — The gums are spongy and tender, and a whitish 

 pellicle often forms which on superficial examination may give the 

 appearance of a purulent exudate. The condition often spreads 

 to the cheeks and lips, and may involve the soft and hard palate 

 and even the tonsils. The pellicle after a time separates, leaving 

 an eroded surface which gradually deepens. 



Chronic Variety.— If untreated the acute and subacute varieties 

 pass into the chronic, and lead in a year or so to destruction of the 

 bony sockets. 



Treatment. — The best treatment for these infections is to remove 

 the tartar, disinfect the mouth with a spray of peroxide of hydrogen 

 or of glycothymoline, and then to treat by ionization with zinc 

 sulphate, and afterwards to use antiseptic washes of sanitas or 

 similar preparations. Roberts recommends the local application of 

 the following : Hydrogen peroxide 5v. , vinum ipecac. 3iii., glycerin 3v., 

 aq. ad §viii. 



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