A 21 year old male patient, with painful gingival inflammation envolving

since 4 days. The patient reported subjective malaise, chills, and

difficulty in eating due to the intensive pain. He had no other significant
medical medical history or known allergies. He had also a stressful job;
he worked as a model and was under severe diet. Intraoral examination
revealed a halitosis, erythematous, and swelling gingival localized at the
buccal side of the upper central, the upper, and lower lateral incisors
and canines. A pseudomembrane formaton along the gingival margins
and decapitated ulcerated papillae.

1. What happen with the patient?

The patient feel painful gingival inflammation since 4 days and the
patient reported malaise, chills, and difficulty eating due to
intensive pain and he had no significant medical history and
allergies because he had stressful job and as a model and under a
severe diet. So intraoral examination is a halitosis, erythematous,
swelling, gingival localized in upper central and upper lower
lateral incisors and canines in buccal side. And the gingival
margins there is a pseudomembrane formation and decapitated
ulcerated papillae. So in the scenario what happen in the patient
is ANUG acute necrotizing ulcerative gingivitis

2. What is the signs and symptoms of the scenario?

Signs :
For extraoral is
- Local lymphadenopathy
- Increace of leukocyte (inflammation agent)
 For Intraoral is

- There is a pseudomembrane, thereby exposing the gingival

margin which is red, shiny, and hemorrhagic
- Erythemathous
- Swelling gingival

Symptom : difficulty in eating due to intensive pain, halitosis,

malaise, chills, painful gingival, metallic taste

3. What is the etiology and predisposition factors of the scenario?

Predisposition factors : stress, nutritional deficiency, pericoronitis,
smoking, vertigo, immune system disfunction especially HIV,
psycosomatic factors

ANUG acute necrotizing ulcerative gingivitis is a multifactoral

disease, and the first factor is bacteria and sice 1866 necrotizing
ulcerative ANUG was cause by specific bacteria such as fuciform
bacilli, prevotella intermedia, treponema, and other bacteria. The
other factor is role of the host response, so if a host immune is
decrease the bacteria will be overgrow

4. What is the relation between stress and disease that attack the
patient?
So stress is one of the factor of predisposition to ANUG by
promoting bacterial growth and decreasing host defences. This
decrease would result in increase levels of corticosteroid and
catecolamin via ANS (Autonomic Nervous System). This could
decrease gingival microsirculation and salivary flux. This hormone
 cause the supretion of leukocyte and lymphocyte function, which
at the same time promote bacterial increasion

5. What is the pathogenesis of the scenario?

Bacteria is the main etiology to ANUG by promoting bacterial
growth and decreasing host defences. This decrease would result
in increase levels of corticosteroid and catecolamin via ANS
(Autonomic Nervous System). This could decrease gingival
microsirculation and salivary flux. This hormone cause the
supretion of leukocyte and lymphocyte function, which at the
same time promote bacterial increasion

6. What is the treatment?

The first treatment of the acute phase has 2 main of objective
therapy to stop disease process but in the scenario patient
haven’t medical history or known allergies and to control patient
general feeling of discomfort with nutrition and oral hygiene
practice
The second treatment of pre existing condition that corrective
treatment of the disease ANUG. Pre existing condition can scaling.
The third treatment is the maintenance phase, is a control plaque
and dental practice at home

Treatment :
- Dibersihkan dengan hydrogen peroksida
- Di irigasi dengan chlor hexidine
- Diberi resep antibiotic dan anti inflamasi, obat kumur
- Edukasi ke pasien supaya menjaga kebersihan mulut, asupan
makanan
- Jika ada kalkulus dilakukan scaling