ACUTE NECROTIZING ULCERATIVE GINGIVITIS

(ANUG)/Periodontitis/Stomatitis

Also known as Vincent’s gingivitis or Vincent’s gingivostomatitis. They are infections characterized by oral
ulcerations and necrosis.

Gingivitis only affects the gums, periodontitis involves the surrounding tissue and attaching the teeth.

In stomatitis, there is widespread involvement of mucosa and bone loss, until the most severe form known as noma
or cancrum oris, leading to extensive destruction of facial tissues and bones.

Inadequately treated ANUG will lapse into a less symptomatic form known as chronic ulcerative gingivitis.

Causes

  • Fusospirochaetal complex together with gram negative anaerobic organisms

Predisposing factors

  • Associated with poor oral hygiene, stress and smoking
  • Uncontrolled diabetes mellitus, and debilitated patients with poor hygiene
  • Malnutrition
  • HIV infection

Clinical features

  • Swelling and erythema of the gingival margins, which bleed easily when touched, causing difficulty drinking and eating
  • Painful papillary yellowish-white ulcers
  • Necrosis and sloughing of gum margins
  • Loss of gingiva and support bone around teeth
  • Foul smelling breath
  • Patient complains of metallic taste and the sensation of their teeth being wedged apart
  • Fever, malaise, and regional lymphadenitis may be present
  • Extensive destruction of the face and jaws in the severe form of Cancrum Oris or noma (in malnourished patients)

Differential diagnosis

  • Dental abscess
  • Swelling due to trauma
  • Acute stomatitis
  • Oral thrush
  • Chemical oral ulcers

MANAGEMENT

General measures

  • Rinse mouth with mouthwash 3 times a day
  • Warm salt solution (5 ml spoonful of salt in 200 ml warm water)
  • Or hydrogen peroxide solution 6%, (add 15 ml to a 200 ml cup of warm water)
  • Or chlorhexidine solution 0.2%
  • Surgical debridement
  • Manage underlying condition
  • Metronidazole 400 mg every 8 hours
    Child: 10-12.5 mg/kg (max 200 mg per dose) every 8 hours
  • Refer to dental specialist