Acute necrotizing ulcerative gingivitis: Difference between revisions
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*Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema spp, Selenomonas, and Prevotella | *Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema spp, Selenomonas, and Prevotella | ||
===Uncomplicated Disease=== | |||
*Antibiotics | *Antibiotics | ||
**Amoxicillin, 250mg 3 x daily for 7 days and/or | **Amoxicillin, 250mg 3 x daily for 7 days and/or | ||
| Line 44: | Line 44: | ||
===Complicated Disease=== | |||
*Antibiotics | *Antibiotics | ||
**Penicillin V 500mg PO q6 hours AND | **[[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]] 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''' | **[[Amoxicillin-clavulanate]] 500mg/125mg PO TID or 875mg/125mg PO BID for 10d '''or''' | ||
**Clindamycin 150-300mg PO TID for 10d '''or''' | **[[Clindamycin]] 150-300mg PO TID for 10d '''or''' | ||
**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> | **[[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> | ||
===Additional=== | |||
*Oral Treatment | *Oral Treatment | ||
**Chlorhexidine 0.01% oral rinse BID | **[[Chlorhexidine]] 0.01% oral rinse BID | ||
**Hydrogen peroxide swishing (cheap home remedy) | **Hydrogen peroxide swishing (cheap home remedy) | ||
*Pain | *Pain | ||
**Ibuprofen 400-600mg 3 times daily | **Ibuprofen 400-600mg 3 times daily | ||
**Mouth cocktail | **Mouth cocktail - 300cc of 1:1:1 viscous lidocaine 2%, Maalox, [[diphenhydramine]] 12.5mg/5ml elixir | ||
*HIV+ | *[[HIV]]+ | ||
**In addition to antibiotic regimen consider an oral anti-fungal or nystatin | **In addition to antibiotic regimen consider an oral anti-fungal or [[nystatin]] | ||
**Fluconazole 200mg PO daily for 14 days | **[[Fluconazole]] 200mg PO daily for 14 days | ||
Revision as of 07:19, 1 August 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
- 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
- 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
Evaluation
- 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 - 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
- ↑ 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.
- ↑ 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
- ↑ Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015
- ER Atlas