Acute necrotizing ulcerative gingivitis: Difference between revisions

Revision as of 01:09, 7 April 2015

Often abbreviated as ANUG

Severe gingival disease that may spread to local soft tissue and bone
Must distinguish from herpes gingivostomatitis
1. Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
Associated with immunosuppression, especially HIV
1. Other associations include poor oral hygeine/nutrition/sleep, stress, ETOH/tobacco use, age<21, Caucasians, malaria/measles/parasites

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

Triad of:
- Pain
- Ulcerated or "punched out" interdental papillae
- Gingival bleeding
Secondary signs:
- Fetid breath
- "Wooden teeth" feeling
- Teeth mobility
- Fever
- Malaise

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

Penicillin V 500 mg PO q6 hours AND Metronidazole 500mg PO q8 hours x 10 days OR
Clindamycin 600 mg PO q8 hours OR
Ampicillin/Sulbactam 3g IV q 6 hours daily

also nystatin oral rinses of 5ml q6 hrs daily for 14 days will help with concominent fungal infection

in addition to antibiotic regimen consider an oral anti-fungal or nystatin

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

Authors:

@@ Line 8: / Line 8: @@
 ==Clinical Features==
-#Triad of:
+[[File:Ulcerative necrotizing gingivitis.jpg|thumb|Mild presentation at the typical site on the gums of the lower front teeth.]]
-##Pain
+*Triad of:
-##Ulcerated or "punched out" interdental papillae
+**Pain
-##Gingival bleeding
+**Ulcerated or "punched out" interdental papillae
-#Secondary signs:
+**Gingival bleeding
-##Fetid breath
+*Secondary signs:
-##"Wooden teeth" feeling
+**Fetid breath
-##Teeth mobility
+**"Wooden teeth" feeling
-##Fever
+**Teeth mobility
-##Malaise
+**Fever
+**Malaise
 ==Differential Diagnosis==