ANUG

Acute necrotizing ulcerative gingivitis or ANUG is a painful infection of the gums. Symptoms include acute pain, bleeding, and bad breath. Diagnosis is based on clinical findings. Treatment is gentle debridement, improved oral hygiene, mouth rinses, supportive care, and, if debridement must be delayed, antibiotics.

Acute necrotizing ulcerative gingivitis otherwise called as ANUG occurs most frequently in smokers and debilitated patients who are under stress. Other risk factors are poor oral hygiene, nutritional deficiencies, immunodeficiency eg, HIV/AIDS, use of immunosuppressive drugs, and sleep deprivation. Some patients also have oral candidiasis.

Symptoms and Signs of ANUG include the following #

• The usually abrupt onset may be accompanied by malaise or fever.

• Acutely painful, bleeding gums

• Excessive salivation

• Sometimes overwhelmingly foul breath called as fetor oris

• Ulcerations, which are pathognomonic, are present on the dental papillae and marginal gingiva. These ulcerations have a characteristically punched-out appearance and are covered by a gray pseudo-membrane.

• Similar lesions on the buccal mucosa and tonsils are rare. Swallowing and talking may be painful sometimes. Regional lymphadenopathy can be seen often.

Etiology Of ANUG #

• ANUG is commonly due to an opportunistic bacterial infection and is predominantly associated with fusiform and spirochete bacteria.

• One study identified spirochetes and a majority of Gram-negative bacteria, including Bacteroides intermedius and Fusobacterium spp as common cause for ANUG.

• Another study described the microbiota associated with ANUG to include `Treponema spp., Selenomonas spp., Fusobacterium spp., and Prevotella intermedia.

Diagnosis of ANUG #

Clinical evaluation include

Rarely, tonsillar or pharyngeal tissues are affected, and diphtheria or infection due to agranulocytosis must be ruled out by throat culture and complete blood count when the gum manifestations do not respond quickly to conventional therapy.

Treatment of ANUG #

• Debridement

• Oral Rinses (eg, hydrogen peroxide, chlorhexidine)

• Maintaining oral hygiene

• Sometimes oral antibiotics can help

• Treatment of ANUG consists of gentle debridement with a hand scaler or ultrasonic device. Debridement is done over several days. The patient uses a soft toothbrush or washcloth to wipe the teeth.

• Rinses at hourly intervals with warm normal saline or twice a day with 1.5% hydrogen peroxide or 0.12% chlorhexidine may help during the first few days after initial debridement of the tissue.

• Essential supportive measures include improving oral hygiene done gently at first, adequate nutrition, high fluid intake, rest, analgesics as needed, and avoiding irritation eg, caused by smoking or hot or spicy foods. Marked improvement usually occurs within 24 to 48 hours, after which debridement can be completed.

• If debridement is delayed eg, if a dentist or the instruments necessary for debridement are unavailable, oral antibiotics eg, amoxicillin 500 mg every 8 hours, erythromycin 250 mg every 6 hours, or tetracycline 250 mg every 6 hours may help to provide relief and can be continued until 72 hours after symptoms resolve.