Acute necrotizing ulcerative gingivitis: Difference between revisions

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'''Uncomplicated Disease'''
'''Uncomplicated Disease'''
*Antibiotics
*Antibiotics
**Amoxicillin, 250 mg 3 x daily for 7 days and/or
**Amoxicillin, 250mg 3 x daily for 7 days and/or
**Metronidazole, 250 mg 3 x daily for 7 days<ref>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</ref>
**Metronidazole, 250mg 3 x daily for 7 days<ref>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</ref>




'''Complicated Disease'''
'''Complicated Disease'''
*Antibiotics
*Antibiotics
**Penicillin V 500 mg PO q6 hours AND Metronidazole 500mg PO q8 hours x 10 days '''or'''
**Penicillin V 500mg 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 500mg PO TID for 10d plus metronidazole 250mg PO TID for 10d '''or'''
**Amoxicillin-clavulanate 500 mg/125mg PO TID or 875mg/125mg PO BID for 10d '''or'''
**Amoxicillin-clavulanate 500mg/125mg PO TID or 875mg/125mg PO BID for 10d '''or'''
**Clindamycin 150-300 mg PO TID for 10d '''or'''
**Clindamycin 150-300mg PO TID for 10d '''or'''
**Doxycycline 100 mg PO BID for 10d<ref>Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015</ref>
**Doxycycline 100mg PO BID for 10d<ref>Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015</ref>




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**Hydrogen peroxide swishing (cheap home remedy)
**Hydrogen peroxide swishing (cheap home remedy)
*Pain
*Pain
**Ibuprofen 400-600 mg 3 times daily
**Ibuprofen 400-600mg 3 times daily
**Mouth cocktail Rx - 300cc of 1:1:1 viscous lidocaine 2%, Maalox, diphenhydramine 12.5mg/5ml elixir
**Mouth cocktail Rx - 300cc of 1:1:1 viscous lidocaine 2%, Maalox, diphenhydramine 12.5mg/5ml elixir
*HIV+
*HIV+

Revision as of 13:36, 21 July 2016

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

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

Diagnosis

  • Usually clinical

Management

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

Uncomplicated Disease

  • Antibiotics
    • Amoxicillin, 250mg 3 x daily for 7 days and/or
    • Metronidazole, 250mg 3 x daily for 7 days[3]


Complicated Disease

  • Antibiotics
    • Penicillin V 500mg PO q6 hours AND Metronidazole 500mg PO q8 hours x 10 days or
    • Amoxicillin 500mg PO TID for 10d plus metronidazole 250mg PO TID for 10d or
    • Amoxicillin-clavulanate 500mg/125mg PO TID or 875mg/125mg PO BID for 10d or
    • Clindamycin 150-300mg PO TID for 10d or
    • Doxycycline 100mg PO BID for 10d[4]


Additional

  • Oral Treatment
    • Chlorhexidine 0.01% oral rinse BID
    • Hydrogen peroxide swishing (cheap home remedy)
  • Pain
    • Ibuprofen 400-600mg 3 times daily
    • Mouth cocktail Rx - 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

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
  • ER Atlas
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