acute necrotizing ulcerative gingivitis; Vincent's angina; trenchmouth; cancrum oris novum; fusospirochetosis (ANUG)

Introduction

Sudden inflammation of the gingivae with necrosis, pain, bleeding & halitosis.

Etiology

• Pseudomonas intermedia
• spirochetes, especially Borrelia vincenti
• anaerobic bacteria in patients with AIDS

Epidemiology

• often occurs after a debilitating illenss
• occurs in malnourished children in underdeveloped countries
• occurs as a complication of leukemia
• occurs in patients with genetic deficiency of catalase
• AIDS

Clinical manifestations

• halitosis
• excessive salivation
• ulceration & necrosis of tonsils & gingiva
  • may create pseudomembrane that bleeds if scraped
• bleeding gums
• bad taste
• cervical lymphadenopathy
• patients may be systemically ill
  • fever
  • leukocytosis

Complications

• infection may spread to buccal mucosa, mandible or maxilla
• tissue destruction (necrosis)

Management

• antibacterial mouth rinses (mouthwash)
• debridement
• systemic antibiotics
  • penicillin
  • metronidazole 250 mg PO TID (anaerobes)
  • clindamycin 300 mg PO TID (anaerobes)
  • amoxicillin clavulanate 250 mg PO TID
  • antipseudomonal agent if Pseudomonas is suspected

More general terms

• gingivitis
• bacterial infection
• angina