Acute Necrotising Ulcerative Gingivitis

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It is a specific gum disease affecting mainly the interdental papillae and gum margin. It affects usually healthy young adults with poor oral hygiene.

Cause

  • Spirochaetes 
  • Gram-negative fusiforms
  • Host factors of poor oral hygiene, cigarette smoking and immune suppression

Symptoms

  • Gum margin soreness or pain of sudden onset
  • Bleeding
  • Malaise
  • Bad taste and foul breath 

Signs

  • Crater-like ulcers and necrosis mainly limited to gum margin and inter-dental gingiva
  • Poor oral hygiene
  • Fever 
  • Lymph node enlargement 

Investigations

  • Swab for culture and sensitivity 

TreatmentTreatment Objectives

  • To eradicate bacterial overgrowth
  • To establish good oral hygiene
  • To control fever and pain

Non-pharmacological treatment

  • Improve oral hygiene habits e.g. brushing at least two times daily, frequent antiseptic oral rinse 

Pharmacological treatment 

For treatment of infection

1st Line Treatment

Evidence Rating: [B]

  • Amoxicillin (Amoxycillin), oral,

Adult

1 g stat.

Then

500 mg 6 hourly for 7 days

Children

7-10 years; 250 mg 6 hourly for 7 days

3-7 years; 125 mg 6 hourly for 7 days

1-3 years; 62.5 mg 6 hourly for 7 days

For Individuals with penicillin allergy

Evidence Rating: [C]

  • Clindamycin, oral,

Adults

150-300 mg 6-8 hourly for 7 days

Children

12-18 years; 150-300 mg 6 hourly for 7 days

1 month-11 years; 3-6 mg/kg 6 hourly for 7 days

For pain and fever control

  • Paracetamol, oral, 

Adults

500 mg-1 g 6 hourly as required 

Children

6-12 years; 250-500 mg 6 hourly as required

1-5 years; 125-250 mg 6 hourly as required

3 months-1 year; 62.5-125 mg 6 hourly as required

Referral Criteria

Refer all patients after initiating therapy to a dentist.