Acute necrotizing ulcerative gingivitis

Notes

## Basic introduction

  • Acute necrotizing ulcerative gingivitis (ANUG) is also known as Vincent’s stomatitis, Vincent’s angina or Trench mouth
  • It is a painful bacterial infection that involves inflammation and ulcers in the gums
  • It can spread to local soft tissue and bone
  • Predisposing factors to ANUG[a]:
  • Adolescents or young adults
  • Cigarettes smokers
  • Psychologically stressed person
  • poverty
  • Pre-existing marginal gingivitis
  • Immunosuppression, mainly HIV
  • Malaria
  • Measles
  • Parasites
  • Caucasians
  • The predisposing factors are thought to influence the reduction of local and general immunity that leads to proliferation of symbiotic bacteria and subsequent formation of lesions[a]

## Statistics

  • The prevalence is less than 5% in developed countries and up to 25% in developing country
Symptoms
  • Rapid onset of gingival pain (chief complaint)
  • Interdental gingival necrosis
  • Bleeding that starts spontaneously or after a gentle touch
  • Ulcers that are covered by a yellowish – white or grayish slough (“Pseudo-membrane”)
  • Destruction of periodontal tissue may remain over a long period of time
  • Regional lymphadenopathy
  • Halitosis
  • Teeth mobility
  • Fetid breath with metallic taste
  • "Wooden teeth" feeling
Diagnosis
  • Clinical review
Differential
  • Primary herpetic gingivostomatitis
  • Acute leukemia
  • Dental caries
  • Gingival hyperplasia
  • Abscesses (periapical, periodontal, or Peritonsillar)
  • Scurvy
  • Ludwig's angina
  • Vincent's angina
Prevention
  • Proper dental hygiene
Reference
  1. Melnick, S. L., Roseman, J. M., Engel, D. A. V. I. D., & Cogen, R. B. (1987). Epidemiology of acute necrotizing ulcerative gingivitis. Epidemiologic reviews, 10, 191-211
  2. Johnson, B. D., & Engel, D. (1986). Acute Necrotizing Ulcerative Gingivitis* A Review of Diagnosis, Etiology and Treatment. Journal of periodontology, 57(3), 141-150.
Management
  • Debridement of dead tissues
  • Salt rinses
  • Hydrogen peroxide to remove dead tissues
  • For the suspected bacterial infection:
  • Caps Amoxicillin 500mg TID x 10/7 (ADD Tabs Metronidazole 250 mg TID x 10/7 in case of infection by Aggregatibacter actinomycetemcomitans).

OR

  • Caps Clindamycin 150-300mg TID x 10/7

OR

  • Caps Doxycycline 100mg BID for 10/7

ADD

  • In HIV positive patient, add: Caps Fluconazole 200mg daily x 2/52
  • Chlorhexidine mouthwash 0.2% - rinse BD (to reduce plaque formation)
  • Topical lignocaine
  • Analgesics
  • Antibiotics regime for severe infections
  • Surgery
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