Acute necrotizing ulcerative gingivitis: Difference between revisions

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==Background==
==Background==
Often abbreviated as ''ANUG''
*Often abbreviated as ''ANUG''
#Severe gingival disease that may spread to local soft tissue and bone
*Severe gingival disease that may spread to local soft tissue and bone
#Must distinguish from herpes gingivostomatitis
*Must distinguish from [[Herpes gingivostomatitis]]
##Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
*Bacteria involved: anaerobic fusobacterium and ''Borellia spirochete''<ref>J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.</ref>
#Associated with immunosuppression, especially HIV
**Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
##Other associations include poor oral hygeine/nutrition/sleep, stress, ETOH/tobacco use, age<21, Caucasians, malaria/measles/parasites
*Associated with <ref>J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.</ref>
**Immunosuppression, especially HIV
**Poor oral hygiene/nutrition/sleep
**Stress
**ETOH/tobacco use
**Age<21
**Caucasians
**malaria/measles/parasites


==Clinical Features==
==Clinical Features==
[[File:Ulcerative necrotizing gingivitis.jpg|thumb|Mild presentation at the typical site on the gums of the lower front teeth.]]
[[File:Ulcerative necrotizing gingivitis.jpg|thumb|Mild presentation at the typical site on the gums of the lower front teeth.]]
*Triad of:
*Triad of:
**Fever
**Pain
**Pain
**Ulcerated or "punched out" interdental papillae
**Regional lymphadenopathy
**Ulcerated, with grayish pseudomembrane or "punched out" interdental papillae
**Gingival bleeding
**Gingival bleeding
*Secondary signs:
*Secondary signs:
**Fetid breath
**Fetid breath with metallic taste
**"Wooden teeth" feeling
**"Wooden teeth" feeling
**Teeth mobility
**Teeth mobility
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{{ANUG Antibiotics}}
{{ANUG Antibiotics}}
#Chlorhexidine 0.01% oral rinse BID
*Chlorhexidine 0.01% oral rinse BID
#Metronidazole 500mg PO TID
*Hydrogen peroxide swishing (cheap home remedy)
*Oropharyngeal coverage:<ref>Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015</ref>
**Amoxicillin 500 mg PO TID for 10d plus metronidazole 250 mg PO TID for 10d '''or'''
**Amoxicillin-clavulanate 500 mg/125 mg PO TID or 875 mg/125 mg PO BID for 10d '''or'''
**Clindamycin 150-300 mg PO TID for 10d '''or'''
**Doxycycline 100 mg PO BID for 10d
 
===Consultation===
===Consultation===
ENT or OMFS consult for dental debridement may be required in severe infections
ENT or OMFS consult for dental debridement may be required in severe infections
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*[[Dental Problems]]
*[[Dental Problems]]


== Source ==
== References ==
<references/>
*ER Atlas
*ER Atlas
*Tintinalli
 
*UpToDate


[[Category:ENT]]
[[Category:ENT]]
[[Category:ID]]
[[Category:ID]]

Revision as of 21:46, 22 April 2015

Background

  • Often abbreviated as ANUG
  • Severe gingival disease that may spread to local soft tissue and bone
  • Must distinguish from Herpes gingivostomatitis
  • Bacteria involved: anaerobic fusobacterium and Borellia spirochete[1]
    • Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
  • Associated with [2]
    • Immunosuppression, especially HIV
    • Poor oral hygiene/nutrition/sleep
    • Stress
    • ETOH/tobacco use
    • Age<21
    • Caucasians
    • malaria/measles/parasites

Clinical Features

Mild presentation at the typical site on the gums of the lower front teeth.
  • Triad of:
    • Fever
    • Pain
    • Regional lymphadenopathy
    • Ulcerated, with grayish pseudomembrane or "punched out" interdental papillae
    • Gingival bleeding
  • Secondary signs:
    • Fetid breath with metallic taste
    • "Wooden teeth" feeling
    • Teeth mobility
    • Fever
    • Malaise

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

Other

Diagnosis

  • Usually clinical

Treatment

Antibiotics

Options

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
  • Hydrogen peroxide swishing (cheap home remedy)
  • Oropharyngeal coverage:[3]
    • Amoxicillin 500 mg PO TID for 10d plus metronidazole 250 mg PO TID for 10d or
    • Amoxicillin-clavulanate 500 mg/125 mg PO TID or 875 mg/125 mg PO BID for 10d or
    • Clindamycin 150-300 mg PO TID for 10d or
    • Doxycycline 100 mg PO BID for 10d

Consultation

ENT or OMFS consult for dental debridement may be required in severe infections

See Also

References

  1. J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.
  2. J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.
  3. Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015
  • ER Atlas