Acute Necrotizing Ulcerative Gingivitis
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Definition
- A polymicrobial, endogenous infection
Aetiology
- Fusiform and spirochaete bacteria
Epidemiology
- In developing countries, seen almost exclusively in children
- Related to poverty and malnutrition (predisposing factors)
- In industrialized countries, most common in young adults with neglected mouths; Immunosuppressive factors, smoking and stress have been associated
Clinical features
- Crater ulcers striating at the tips of the interdental papillae
- Ulcers spread along gingival margins
- Gingival soreness and bleeding
- Foul breath
- Metallic taste
- Increased salivation
- Cervical lymphadenopathy and fever in advanced cases
Differential diagnoses
- Primary herpetic gingivo-stomatitis
- HIV-associated acute ulcerative gingivitis
- Gingival ulceration in acute leukaemia or aplastic anaemia
Investigations
- Smears from ulcers show predominantly spirochaetes and gram-negative fusiform bacteria
Treatment goals
- Treat infection
- Restore oral health
Non-drug treatment
- Oral hygiene (debridement) is essential
Drug treatment
- Metronidazole
- Adult: 200 mg orally 8 hourly for 3 days
- Child:
- 1-3years: 50mg orally every 8 hours for 3 days;
- 3-7years: 100mg every12 hours;
- 7 - 10 years: half adult dose
Supportive therapy
- Ascorbic acid
- Adult: not less than 250 mg orally daily (in divided doses)
- Child:
- 1 month - 4 years: 125 - 250 mg in 1 - 2 divided doses
- 4-12 years: 250-500 mg daily in 1-2 divided doses;
- 12 - 18 years 500 mg - 1 g daily in 1 - 2 divided doses
- Ferrous sulfate
- Adult: 200 mg orally three times daily taken before food
- Child 6-12 years: half adult dose
Follow-up treatment
- Rehabilitation of the mouth
- Once the acute phase has subsided, oral hygiene should be brought to as high a standard as possible to lessen the risk of recurrence
- Sequestrectomy
Notable adverse drug reactions, complications and caution
- Metronidazole: nausea, vomiting, unpleasant taste; disulfiram-like effect with alcohol.