Acute necrotizing ulcerative gingivitis: Difference between revisions
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==Treatment== | ==Treatment== | ||
{{ANUG Antibiotics}} | {{ANUG Antibiotics}} | ||
*Chlorhexidine 0.01% oral rinse BID | *Chlorhexidine 0.01% oral rinse BID | ||
*Hydrogen peroxide swishing (cheap home remedy) | *Hydrogen peroxide swishing (cheap home remedy) | ||
*Oropharyngeal coverage:<ref>Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015</ref> | *Oropharyngeal coverage:<ref>Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015</ref> | ||
**Penicillin V 500 mg PO q6 hours AND Metronidazole 500mg PO q8 hours x 10 days '''or''' | |||
**Amoxicillin 500 mg PO TID for 10d plus metronidazole 250 mg PO TID for 10d '''or''' | **Amoxicillin 500 mg PO TID for 10d plus metronidazole 250 mg PO TID for 10d '''or''' | ||
**Amoxicillin-clavulanate 500 mg/125 mg PO TID or 875 mg/125 mg PO BID for 10d '''or''' | **Amoxicillin-clavulanate 500 mg/125 mg PO TID or 875 mg/125 mg PO BID for 10d '''or''' | ||
**Clindamycin 150-300 mg PO TID for 10d '''or''' | **Clindamycin 150-300 mg PO TID for 10d '''or''' | ||
**Doxycycline 100 mg PO BID for 10d | **Doxycycline 100 mg PO BID for 10d | ||
HIV+ | |||
*In addition to antibiotic regimen consider an oral anti-fungal or nystatin | |||
**Fluconazole 200mg PO daily for 14 days | |||
===Consultation=== | ===Consultation=== | ||
Revision as of 21:48, 22 April 2015
Background
- 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 with [2]
- Immunosuppression, especially HIV
- Poor oral hygiene/nutrition/sleep
- Stress
- ETOH/tobacco use
- Age<21
- Caucasians
- malaria/measles/parasites
Clinical Features
- Triad of:
- Fever
- Pain
- Regional lymphadenopathy
- Ulcerated, with grayish pseudomembrane or "punched out" interdental papillae
- Gingival bleeding
- Secondary signs:
- Fetid breath with metallic taste
- "Wooden teeth" feeling
- Teeth mobility
- Fever
- Malaise
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
Other
Diagnosis
- Usually clinical
Treatment
- Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema spp, Selenomonas, and Prevotella
Options
- 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
HIV positive
in addition to antibiotic regimen consider an oral anti-fungal or nystatin
- Fluconazole 200mg PO daily for 14 days
- Chlorhexidine 0.01% oral rinse BID
- Hydrogen peroxide swishing (cheap home remedy)
- Oropharyngeal coverage:[3]
- Penicillin V 500 mg PO q6 hours AND Metronidazole 500mg PO q8 hours x 10 days or
- Amoxicillin 500 mg PO TID for 10d plus metronidazole 250 mg PO TID for 10d or
- Amoxicillin-clavulanate 500 mg/125 mg PO TID or 875 mg/125 mg PO BID for 10d or
- Clindamycin 150-300 mg PO TID for 10d or
- Doxycycline 100 mg PO BID for 10d
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
See Also
References
- ↑ J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.
- ↑ J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.
- ↑ Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015
- ER Atlas