Acute necrotizing ulcerative gingivitis: Difference between revisions
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==Treatment== | ==Treatment== | ||
*Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema spp, Selenomonas, and Prevotella | |||
*Chlorhexidine 0.01% oral rinse BID | *Chlorhexidine 0.01% oral rinse BID | ||
*Hydrogen peroxide swishing (cheap home remedy) | *Hydrogen peroxide swishing (cheap home remedy) | ||
Revision as of 21:50, 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
- 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
- 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
Diagnosis
- Usually clinical
Treatment
- Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema spp, Selenomonas, and Prevotella
- Chlorhexidine 0.01% oral rinse BID
- Hydrogen peroxide swishing (cheap home remedy)
- Oropharyngeal coverage:[3]
- Penicillin V 500 mg PO q6 hours AND Metronidazole 500mg PO q8 hours x 10 days or
- 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
HIV+
- In addition to antibiotic regimen consider an oral anti-fungal or nystatin
- Fluconazole 200mg PO daily for 14 days
Consultation
ENT or OMFS consult for dental debridement may be required in severe infections
See Also
References
- ↑ J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.
- ↑ J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.
- ↑ Stephen J. et al Acute Necrotizing Ulcerative Gingivitis Empiric Therapy. http://emedicine.medscape.com/article/2028117-overview. Accessed April 2015
- ER Atlas