Acute Necrotizing Ulcerative Gingivitis (ANUG)

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Acute necrotizing ulcerative gingivitis (ANUG) is a serious infection of the gums that causes ulcers, swelling, and dead tissues in the mouth.

Causes

  • Fusiform and Spirochete bacteria.

Signs and symptoms

  • Acutely and severe gum pain.
  • Excessive salivation
  • Sometimes overwhelmingly foul breath (fetor oris)
  • Profuse gum bleeding that requires little or no provocation.
  • Interdental papillae are ulceratedwith dead tissue

Differential diagnosis

  • Primary herpetic gingiva-stomatitis

Investigations/Diagnosis

  • Clinical evaluation
  • Smear for fusospirochete bacteria

Treatment objectives

  • Treat Infection
  • Restore oral health

Non-pharmacological treatment

  • Primary first-line
    • Proper Oral hygiene; twice daily brushing and daily flossing
  • Debridement
  • Sequestrectomy

Pharmacological treatment

For systemic signs of infection

Amoxicillin oral

500 mg 3 times daily for 10 days

AND

Metronidazole oral

400mg three times daily for 10 days

OR

Amoxicillin/clavulanic acid oral

500 mg/125 mg three times daily for 10 days

OR

Amoxicillin/clavulanic acid oral

875 mg/125 mg two times daily for 10 days

OR

Clindamycin oral

150-300 mg three times daily for 10 days

OR

Doxycycline oral

100 mg two times daily for 10 days

Adjunctive therapy includes:

  • Saline rinses or hydrogen peroxide 3% solution or over-the-counter oxygenating mouth rinses can help to speed resolution
  • Chlorhexidine 0.12% oral rinse 15 mL two times daily
  • For patients who are human immunodeficiency virus (HIV) positive, nystatin rinse 5 mL 4 times daily or fluconazole oral 200 mg daily for 7-14 days
  • Patients with ANUG should be given a topical anaesthetic and nonsteroidal anti-inflammatory drugs (NSAIDs) because pain control is very important in allowing the patient to perform good oral hygiene

Prevention

  • Take proper care of teeth and gums.
  • Regular dental check-up.
  • Eat balanced diet