Acute Necrotising Ulcerative Gingivitis (ANUG)

(also known as ulcerative gingivitis, Vincent’s gingivitis, ulceromembranous gingivitis or trench mouth)

(c.f.Vincent’s angina - a fusospirochaetal infection, typically localized over the tonsils)

Clinical presentation

• Painful papillary yellowish white ulcers which bleed readily
• Metallic taste
• Sensation of teeth being wedged apart
• Regional lymphadenitis
• Fever
• Malaise
• Poor oral hygiene
• Stress and smoking

Complications

Cancrum oris or norma - extensive destruction of jaws and face (in malnourished patients) - rare

Treatment

Usually self limiting

• LA, infiltration or block (see dental anaesthesia)
• Debridement and adequate oral hygiene
• Chlorhexidine (0.2%) mouth wash
• Lignocaine mouthwash prn for pain relief
• Systemic analgesics prn
• Metronidazole 200mg tds for 3 days (if regional lymphadenopathy)

Follow-up

• Dental surgeon / periodontist

Dr George Chu BDSc MBBS
Ed: Dr. Derek Louey MBBS FACEM