Acute necrotizing ulcerative gingivitis

Background

  • Also known as "trench mouth"
  • Often abbreviated as ANUG
  • Some literature equates as the same as Vincent's angina, and other literature suggests ANUG and Vincent's angina are different
  • Severe gingival disease that may spread to local soft tissue and bone
  • Must distinguish from Herpes gingivostomatitis
    • Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
  • Bacteria involved: anaerobic fusobacterium and Borellia spirochete[1], Treponema, Selenomonas, Prevotella

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
  • Blunting of the typically pointed edges of the 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

Additional Therapies for the immunocompromised

For patient with AIDS or immunocompromised with risk of oral candidal infection then add:

  • Nystatin oral rinse four times daily x 14 days OR
  • [[Fluconazole] 200mg PO daily x 14 days

Additional Therapies for all patients

  • Chlorhexidine 0.01% oral rinse BID
  • Hydrogen peroxide swishing (innexpensive home remedy)
  • Ibuprofen 400-600mg 3 times daily for pain
    • Magic Mouthwash (multiple variations) - 300cc of 1:1:1 viscous lidocaine 2%, Maalox, diphenhydramine 12.5mg/5ml elixir

Consultation

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

Disposition

Discharge

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. Walker C. et al. Rationale for use of antibiotics in periodontics. J Periodontol. 2002. 73(1):1188-96

Authors:

Ross Donaldson