ACUTE NECROTISING ULCERATIVE GINGIVITIS.
What is ANUG ?
Acute disease with repeated remission exacerbation seen with impaired host characterized by death and sloughing of gingival tissue .
Nicknames for ANUG ?
Trench mouth.
Vincent angina.
Vincent's stomatitis.
Fetid stomatitis.
Purid stomatitis.
Why it is called Trench mouth ?
The term trench mouth can be tracked during World War 1, where it was very common for the soldiers to experience severe gum problems ,
Because they didn't have access to Dental Care.
https://youtu.be/Xwo4aFYhiT8
Predisposing factors
1) Pre-existing gingivitis
2) Injury to gingiva.
3) Nutritional deficiency.
4) Smoking.
5) Deliberating Disease.
Oral signs and symptoms .
Intraoral features.
1) The lesion is extremely painful.
2) Constant radiating gnawing pain.
3) Metallic foul taste.
4) Secretion of pasty saliva.
5) Spontaneous breathing from gingival tissue.
6) Deep ulceration which involves necrosis of tissue.
7) Teeth are slightly extruded and sensitive to pressure.
8) Patient experience loss of taste and Woody sensation.
9) Punched out crator like depressions, present at the crest of interdental papilla.
10) The craters are caused by pseudomembraneous slough.
Extra oral features.
1) Local lymphadenopathy.
2) Slight elevation of temperature.
3) Leukocytosis.
4) Increase pulse rate.
5) Loss of appetite.
Let's understand the microbiology behind it.
It is a fusospirochetal infection.
According to Horning and Cohan give the stages of necrotising disease.
Stage 1 necrotizing ulcerative gingivitis.
Stage 2 Nug periodontitis.
Stage 3 and 4 correspond to Nug.
Stage 5 and 6 corresponding to necrotising stomatitis.
Stage 7 would be NOMA.
Treatment
First visit
1) First applied topical anaesthesia on the involve areas.
2) The areas are gently swabbed to remove the pseudo membrane.
3) Superficial calculus is removed with ultrasonic scaler.
4) Rinse mouth everyday in every 2 hours with glass full of equal mixture of warm water and 3% of hydrogen peroxide.
5) Amoxicillin 250 mg for 500 mg 250 QID and metronidazole 250 mg or 500 mg may be taken.
Second visit
Scaling is performed after 1 to 2 days.
Third visit
After one or two days of second visit scaling and root planing are treated with plaque control instruction hydrogen peroxide rinses are discontinued but chlorhexidine rinses is can be maintained for two to three weeks.
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