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Acute necrotizing ulcerative gingivitis
From WikEM
Contents
Background
- Also known as "trench mouth"
- 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 Conditions[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
- Dental caries (pulpitis)
- Ludwig's angina
- Periapical abcess
- Periodontal abscess
- Peritonsillar Abscess (PTA)
- Retropharyngeal abscess
- Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)
- Vincent's angina - tonsillitis and pharyngitis
- Acute alveolar osteitis
Other
- Scurvy
- Gingival hyperplasia
- Phenytoin
- Cyclosporine
- Nifedipine, Amlodipine
- Leukemia
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
Authors
Aaron Snyder, Ross Donaldson, Kenn Ghaffarian, Yos Yachivev, Kevin Lu, Neil Young
