J Periodontal Implant Sci.  2015 Dec;45(6):252-256. 10.5051/jpis.2015.45.6.252.

Two cases of an atypical presentation of necrotizing stomatitis

• Magan-Fernandez A
• O'Valle F
• Pozo E
• Liebana J
• Mesa F

• KMID: 2354944
• DOI: http://doi.org/10.5051/jpis.2015.45.6.252

Abstract

PURPOSE
The purpose of this report was to describe the clinical and microbiological characteristics of two rare cases of necrotizing stomatitis, and the outcomes of a non-invasive treatment protocol applied in both cases.
METHODS
We report two cases of necrotizing stomatitis in a rare location in the hard palate of a 40-year-old woman and a 28-year-old man. Neither had a relevant medical history and both presented with highly painful ulceration in the palate and gingival margin that was accompanied by suppuration and necrosis. 3% hydrogen peroxide was applied to the lesions using sterile swabs, and antibiotic and anti-inflammatory treatment was prescribed to both patients in addition to two daily oral rinses of 0.2% chlorhexidine.
RESULTS
In both cases, radiological examination ruled out bone involvement, and exfoliative cytology revealed a large inflammatory component and the presence of forms compatible with fusobacteria and spirochetes. There was a rapid response to treatment and a major improvement was observed after 48 hours, with almost complete resolution of the ulcerated lesions and detachment of necrotic areas with partial decapitation of gingival papillae.
CONCLUSIONS
Necrotizing periodontal lesions can hinder periodontal probing and the mechanical removal of plaque in some cases due to the extreme pain suffered by the patients. We present a non-invasive treatment approach that can manage these situations effectively.

Keyword

Histology; Microbiology; Necrotizing stomatitis; Necrotizing ulcerative gingivitis

MeSH Terms

Adult
Chlorhexidine
Clinical Protocols
Decapitation
Female
Fusobacteria
Gingivitis, Necrotizing Ulcerative
Humans
Hydrogen Peroxide
Necrosis
Palate
Palate, Hard
Spirochaetales
Stomatitis*
Suppuration
Ulcer
Chlorhexidine
Hydrogen Peroxide

Figure

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  Figure 1 (A) Clinical photograph of the lesions presented in case 1 at the time of examination. (B) Clinical photograph of the lesions presented in case 1 after 48 hours.

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  Figure 2 (A) Clinical photograph of the lesions presented in case 2 at the time of examination. (B) Clinical photograph of the lesions presented in case 2 after 48 hours.

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  Figure 3 (A) Panoramic X-ray of the patient in case 1. (B) Panoramic X-ray of the patient in case 2.

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  Figure 4 (A) Histologic image from exfoliative cytology showing acute inflammatory cells along with desquamated epithelial cells in case 1. (B) Histologic image from exfoliative cytology showing forms compatible with spirochetes and fusiform bacteria in case 2.

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