Acute necrotizing ulcerative gingivitis

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Background

  • Also known as "trench mouth"
  • Often abbreviated as ANUG
  • Severe gingival disease that may spread to local soft tissue and bone
  • Must distinguish from Herpes gingivostomatitis
  • Bacteria involved: anaerobic fusobacterium and Borellia spirochete[1]
    • Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement

Associated Conditions[2]

Clinical Features

Mild presentation at the typical site on the gums of the lower front teeth.

Early

  • Fever
  • Halitosis
  • Pain
  • Gingival bleeding
  • Teeth mobility
  • Malaise

Secondary signs

  • Fetid breath with metallic taste
  • "Wooden teeth" feeling
  • Regional lymphadenopathy
  • Ulcerated, with grayish pseudomembrane or "punched out" interdental papillae

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

Other

Evaluation

  • Usually clinical

Management

  • Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema spp, Selenomonas, and Prevotella

Uncomplicated Disease

Complicated Disease

Additional

  • Oral Treatment
    • Chlorhexidine 0.01% oral rinse BID
    • Hydrogen peroxide swishing (cheap home remedy)
  • Pain
    • Ibuprofen 400-600mg 3 times daily
    • Mouth cocktail - 300cc of 1:1:1 viscous lidocaine 2%, Maalox, diphenhydramine 12.5mg/5ml elixir
  • HIV+
    • In addition to antibiotic regimen consider an oral anti-fungal or nystatin
    • Fluconazole 200mg PO daily for 14 days

Consultation

ENT or OMFS consult for dental debridement may be required in severe infections

Disposition

See Also

References

  1. J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.
  2. J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.
  3. Atout R. N. et al. Managing Patients with Necrotizing Ulcerative Gingivitis. J Can Dent Assoc 2013;79:d46. http://www.jcda.ca/article/d46. Accessed April 2015
  4. Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015