A case series of necrotizing periodontal diseases in hospitalized patients: What hasn't been said yet?

BACKGROUND: Necrotizing periodontal diseases (NPDs) are uncommon and severe inflammatory conditions characterized by tissue necrosis, painful ulceration, and rapid clinical progression, frequently associated with systemic immunosuppression. Limited data exist regarding their clinical presentation and management in hospital settings. METHODS: This retrospective case series included 10 inpatients diagnosed with NPDs across two hospitals. Patients had diverse underlying systemic conditions associated with impaired immune function. Clinical features, diagnostic approaches, microbiological findings, and therapeutic strategies were analyzed and are reported in this paper. RESULTS: All patients exhibited rapid periodontal tissue breakdown with variable extension to adjacent oral mucosa. Unusual opportunistic pathogens, rarely described in the context of NPDs, were identified in several cases. Management included systemic antimicrobial therapy, local periodontal debridement, and, in selected cases, adjunctive antimicrobial photodynamic therapy. Clinical outcomes varied according to systemic status and the timing of intervention. CONCLUSIONS: NPDs in hospitalized immunocompromised patients may present atypically and involve non-classical pathogens. Early recognition and individualized multidisciplinary management are essential to prevent disease progression and systemic complications. KEY POINTS: Purplish gingival lesions may precede necrosis, and perhaps they could represent an early clinical sign. The oral cavity can act as a reservoir for opportunistic pathogens not traditionally associated with periodontal diseases. Antimicrobial photodynamic therapy may be used as an adjunctive therapy and has shown favorable clinical outcomes in some cases of this series. PLAIN LANGUAGE SUMMARY: Necrotizing periodontal diseases (NPDs) are severe infections characterized by gum necrosis, pain, and rapid destruction of tissues. These conditions are more commonly observed in immunocompromised individuals and may occur in hospitalized patients with systemic diseases. In this study, we describe a series of 10 hospitalized patients who presented with NPD, and we write about the clinical aspect, including the bluish discoloration that is rarely discussed in the literature. Treatment approaches varied according to the clinical conditions of each patient and included broad-spectrum antibiotics and, in some cases, antimicrobial photodynamic therapy (aPDT) as an adjunctive approach. All patients showed clinical improvement after treatment. These findings suggest that early diagnosis and appropriate management are essential in medically compromised patients, and that aPDT may represent a useful adjunctive therapy.