Acute necrotizing ulcerative gingivitis: Difference between revisions
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==Treatment== | ==Treatment== | ||
===[[Antibiotics]]=== | |||
{{ANUG Antibiotics}} | |||
#Chlorhexidine 0.01% oral rinse BID | #Chlorhexidine 0.01% oral rinse BID | ||
#Metronidazole 500mg PO TID | #Metronidazole 500mg PO TID | ||
===Consultation=== | |||
ENT or OMFS consult for dental debridement may be required in severe infections | |||
==See Also== | ==See Also== |
Revision as of 22:18, 6 April 2015
Background
Often abbreviated as ANUG
- Severe gingival disease that may spread to local soft tissue and bone
- Must distinguish from herpes gingivostomatitis
- Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
- Associated with immunosuppression, especially HIV
- Other associations include poor oral hygeine/nutrition/sleep, stress, ETOH/tobacco use, age<21, Caucasians, malaria/measles/parasites
Clinical Features
- Triad of:
- Pain
- Ulcerated or "punched out" interdental papillae
- Gingival bleeding
- Secondary signs:
- Fetid breath
- "Wooden teeth" feeling
- Teeth mobility
- Fever
- Malaise
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
Other
Treatment
Antibiotics
- Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema spp, Selenomonas, and Prevotella
Options
- Penicillin V 500 mg PO q6 hours AND Metronidazole 500mg PO q8 hours x 10 days OR
- Clindamycin 600 mg PO q8 hours OR
- Ampicillin/Sulbactam 3g IV q 6 hours daily
also nystatin oral rinses of 5ml q6 hrs daily for 14 days will help with concominent fungal infection
HIV positive
in addition to antibiotic regimen consider an oral anti-fungal or nystatin
- Fluconazole 200mg PO daily for 14 days
- Chlorhexidine 0.01% oral rinse BID
- Metronidazole 500mg PO TID
Consultation
ENT or OMFS consult for dental debridement may be required in severe infections
See Also
Source
- ER Atlas
- Tintinalli
- UpToDate