Acute necrotizing ulcerative gingivitis



Acute necrotizing ulcerative gingivitis (ANUG), trenchmoith is a common, non-contagious infection of the gums with sudden onset. 



The main features are painful, bleeding gums, and ulceration of inter-dental papillae.



Acute necrotizing ulcerative gingivitis disease, along with necrotizing (ulcerative) periodontitis (NP or NUP) is classified as a necrotizing periodontal disease, one of the seven general types of gum disease caused by inflammation of the gums.



Necrotizing gingivitis is part of a spectrum of disease termed necrotizing periodontal diseases. 



It is the most minor form of this spectrum.



Typical site of involvement on the gums of the anterior mandibular teeth.



Severe gum pain in ANUG distinguishes it from the more common chronic periodontitis which is rarely painful. 



If improperly treated or neglected, it may become chronic and/or recurrent. 



Causative organisms are mostly anaerobic bacteria, particularly Fusobacteria and spirochete species.



ANUG predisposing factors include:  poor oral hygiene, smoking, poor nutrition, psychological stress, and a weakened immune system. 



When the attachments of the teeth to the bone are involved, the term NUP is used. 



Treatment is by removal of dead gum tissue and antibiotics in the acute phase, and improving oral hygiene to prevent recurrence. 



Metronidazole is usually used.



The process usually resolves quickly and does no serious harm. 



The term name trench mouth arose during World War I as many soldiers developed the disease because of the poor conditions and extreme psychological stress.



Early stages may be associated with complaints of tightness around the teeth.






Severe gum pain.



Profuse gum bleeding that requires little or no provocation.



Interdental papillae are ulcerated with dead tissue.



Foul breath.



Bad taste with a metallic taste



Malaise, fever and/or cervical lymph node enlargement are rare.



Pain is fairly well localized to the affected areas.



Systemic reactions may be more pronounced in children.



Necrotizing periodontal disease is caused by a mixed bacterial infection that includes anaerobes such as P. intermedia and Fusobacterium as well as spirochetes, such as Treponema.



ANUG may also be associated with diseases in which the immune system is compromised, including HIV/AIDS.



It is an opportunistic infection that occurs on a background of impaired local or systemic host defenses. 



Predisposing factors are smoking, psychological stress, malnutrition, and immunosuppression.



Diagnosis is usually clinical.



It must be differentiated from acute leukemia or herpetic stomatitis.



It is the most minor form of this spectrum, with more advanced stages being termed necrotizing periodontitis, necrotizing stomatitis, and the most extreme, cancrum oris. 



Acute necrotizing ulcerative gingivitis (ANUG) refers to the clinical onset of NUG. 



The word acute is used because usually the onset is sudden, while other forms of NUG may be chronic or recurrent.



Progression of the disease into tissue beyond the mucogingival junction characterizes necrotizing stomatitis.



Treatment includes irrigation and debridement of necrotic areas, areas of dead and/or dying gum, oral hygiene instruction and the uses of mouth rinses and pain medication. 



With evidence of systemic involvement, oral antibiotics may be given(metronidazole).



Proper management of the systemic disorders is appropriate.



Untreated, AUNG may lead to rapid destruction of the periodontium and can spread, as necrotizing stomatitis into neighbouring tissues in the cheeks, lips or the bones of the jaw. 



ANUG can occur and be especially dangerous in people with weakened immune systems. 



In developed countries, ANUG occurs mostly in young adults. 



In developing countries, ANUG may occur in children of low socioeconomic status, usually occurring with malnutrition and shortly after the onset of viral infections.



Predisposing factors include: smoking, viral respiratory infections and immune defects, such as in HIV/AIDS. 



Process is uncommon, except in lower socioeconomic classes



Typically affects adolescents and young adults, especially in institutions, armed forces, and people with HIV/AIDS.



It has occurred in epidemic-like patterns. 



It is not contagious.


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