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.