Acute Necrotizing Ulcerative Gingivitis (ANUG)

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It is a severe form of gingivitis and is characterized by rapid destruction of gingival tissue, particularly in the interdental papilla. Patients usually present with soreness and bleeding of the gums and foul smell test (fetor-ex ore/halitosis). It is common in malnourished children and immunocompromised  individuals especially patients with diabetes and HIV/AIDS. 

Clinical presentation 

• Painful swollen gingiva which bleeds easily and erythema of the gingival margins
• Yellowish-white ulceration of the gingival
• Fever, malaise, and regional lymphadenitis
• In  some  patients  (especially  malnourished  children),  ANUG  may  presents  with extensive destruction of the face and jaws in the severe form known as Cancrum Oris

Pharmacological Treatment  

Professional cleaning with hydrogen peroxide 3% (under local anesthesia) 

A: metronidazole (PO) 400 mg 8hourly for 5days 

AND 

A: amoxicillin (PO) 500mg 8hourly for 5days