The most fulminate form of gingivitis is necrotizing ulcerative gingivitis (NUG) (previously called acute NUG, "trench mouth" or "Vincent's infection"). It is a very painful, fetid, ulcerative disease that occurs most often in persons under severe stress with no or very poor oral hygiene. It is manifested by acutely tender, inflamed, bleeding gums associated with the interdental papillae necrosis and loss. Halitosis and fever are often present. Microbiological examinations of the bacterial biofilms found in NUG revealed high numbers of spirochetes and fusobacteria (39-41).
Another form of fulminate gingivitis is acute streptococcal gingivitis. It is caused by Group A beta-hemolytic streptococci (Streptococcus pyogenes) and is generally associated with acute streptococcal tonsillitis.
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