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Acute Necrotizing Ulcerative Gingivitis

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Acute Necrotizing Ulcerative Gingivitis, ANUG, Trench Mouth, Vincent's Stomatitis

  • Pathophysiology
  1. Acute fusospirochetal infection of the Gingiva
  • Risk Factors
  1. Emotional stress
  2. HIV Infection
  3. Tobacco abuse
  4. Poor Oral Hygiene
  5. Nutritional deficiency
  • Findings
  • Signs and symptoms
  1. Systemic symptoms
    1. Fever
    2. Malaise
    3. Lymphadenopathy
  2. Mnemonic: "3 B's"
    1. Bad breath (Fetor Oris from tissue necrosis)
    2. Bad taste
    3. Gingival Bleeding
  3. Painful Gingivitis
    1. Redness
    2. Swelling
    3. Oral Ulcers
  4. Specific oral findings
    1. Punched out lesions on interdental papillae
    2. Mucus membranes covered with grayish necrotic pseudomembrane
      1. Surface bleeds when removed
  • Differential Diagnosis
  • Management
  1. Good Oral Hygiene
  2. Refer to Dentistry for debridement
  3. Antibiotics (if systemic symptoms)
    1. Metronidazole (Flagyl) 250-500 mg orally three times daily for 7 days AND
    2. Amoxicillin 1000 mg twice daily for 7 days
  • References
  1. Broderick and Deak (2015) Crit Dec Emerg Med 29(1): 2-8
  2. Atout (2013) J Can Dent Assoc 79:d46 [PubMed]