An Atypical Case of Necrotizing Periodontal Disease: A Case Report Necrotizing periodontitis

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Swati Y Rawal, Dr. Xin-Yan Lim, Dr. Suan-Phaik Khoo, Dr. Vrisiis Kofina, Dr.


Necrotizing periodontal disease and necrotizing stomatitis are a group of necrotizing diseases involving different structures of the oral cavity. Necrotizing periodontal disease includes necrotizing periodontitis and necrotizing gingivitis. It involves destruction of the supporting periodontium leading to premature tooth loss. Necrotizing stomatitis destroys soft tissue in the oral cavity and its underlying connective tissue, leaving behind a raw area which predisposes it to infection. This case report presents a case of necrotizing stomatitis preceded by necrotizing periodontitis in a well-nourished individual whose only concern was psychological stress and lack of sleep. These diseases are commonly seen in HIV-seropositive or immune-compromised individuals. They are uncommon in well-nourished individuals who are systemically healthy.  In this case, the complex role of psychological stress and sleep deprivation may have played a role in poor healing. The patient made an uneventful recovery as stress levels declined over time.

Keywords: Necrotizing periodontal disease, Necrotizing stomatitis, Psychological stress, Necrotizing periodontitis

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How to Cite
RAWAL, Swati Y et al. An Atypical Case of Necrotizing Periodontal Disease: A Case Report. Medical Research Archives, [S.l.], v. 10, n. 12, jan. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 29 jan. 2023. doi:
Case Reports


1. Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Periodontol 2018;89 Suppl 1: S85-S102
2. Watanabe K. Prepubertal periodontitis: a review of diagnostic criteria, pathogenesis, and differential diagnosis. J Periodontal Res 1990; 25:31–34
3. EC-Clearinghouse on oral problems related to HIV infection and WHO collaborating center on oral manifestations of the immunodeficiency virus: classification and diagnostic criteria for oral lesions in HIV-infection. J Oral Pathol Med 1993; 22:289-291.
4. Todescan S, Nizar R. Managing patients with necrotizing ulcerative periodontitis. Journal Canadian Dental Association. 2013;79: d44.
5. Ranganathan, K.; Hemalatha, R. (2006). Oral lesions in HIV infection in developing countries: an overview. Adv. Dent. Res., 19 (1), 63-68.
6. Horning GM, Cohen ME. Necrotizing ulcerative gingivitis, periodontitis, and stomatitis: clinical staging and predisposing factors. J Periodotol. 1995 Nov;66(11):990-998.
7. Tiitta O, Luomanen M, Hietanen J, Virtanen I. Tenascin expression in mucocutaneous diseases and related lesions of human oral mucosa. Archives of oral biology. 1995 Nov 1;40(11):1039-1045.
8. Herrera D, Alonso B, de Arriba L, Santa Cruz I, Serrano C, Sanz M. Acute periodontal lesions. Periodontol 2000 2014; 65:149-177.
9 Mesa et al. Catecholamine metabolites in urine, as chronic stress biomarkers, are associated with higher risk of chronic periodontitis in adults. J Periodontol 2014;85:1755-1762.
10. Gaetti-Jardim Júnior E, Nakano V, Wahasugui TC, Cabral FC, Gamba R, Avila-Campos MJ. Occurrence of yeasts, enterococci and other enteric bacteria in subgingival biofilm of HIV-positive patients with chronic gingivitis and necrotizing periodontitis. Brazilian Journal of Microbiology. 2008 Jun;39(2):257-261.
11. Chidzonga MM, Mahomva L. Noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): clinical experience in Zimbabwe. J Oral Maxillofac Surg. 2008; 66:475-485.
12. Enwonwu CO, Falkler WA Jr, Phillips RS. Noma (cancrum oris). Lancet. 2006; 368:147-156.
13. Spector, A.M., Postolache, T.T., Akram, F. et al. Psychological Stress: A Predisposing and Exacerbating Factor in Periodontitis. Curr Oral Health Rep.2020; 7, 208–215.
14. McEwen BS. Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583(2–3):174–85.
15. Decker A., Askar, H., Tattan, M. et al. The assessment of stress, depression, and inflammation as a collective risk factor for periodontal diseases: a systematicreview. Clin Oral Invest. 2020; 24, 1–12. htps://
16. Glaser R Kiecolt-Glaser JK. Stress-induced immune dysfunction: Implications for health. Nature Reviews Immnology 2005; 5:243–251.
17. Kiecolt-Glaser JK, Loving TJ, Stowell JR, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry 2005; 62:1377–1384.
18. Broadbent E, Petrie KJ, Alley PG, et al. Psychological stress impairs early wound repair following surgery. Psychosom Med 2003;65(5):865–869.
19. Padgett DA, Marucha PT, Sheridan JF. Restraint stress slows cutaneous wound healing in mice. Brain Behav Immun 1998; 12:64–73.