What is ANUG?

Acute necrotizing ulcerative gingivitis (ANUG) is a rapidly destructive, non-communicable microbial disease of the gingiva in the context of an impaired host immune response. It is characterized by the sudden onset of inflammation, pain, and the presence of "punched-out" crater-like lesions of the papillary gingiva.

What are the symptoms of ANUG?

Can ANUG go away on its own?

ANUG is very treatable and completely reversible if caught early.

Is ANUG serious?

Acute necrotizing ulcerative gingivitis (ANUG) is a serious infection of the gums.

How is ANUG treated?

Treatment of ANUG is by removal of dead gum tissue and antibiotics (usually metronidazole) in the acute phase, and improving oral hygiene to prevent recurrence. Although the condition has a rapid onset and is debilitating, it usually resolves quickly and does no serious harm.

Acute Necrotizing Ulcerative Gingivitis (ANUG)

Why do people get ANUG?

Acute necrotizing ulcerative gingivitis (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.

What is the cause of ANUG?

Etiology. 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.

Can ANUG be caused by stress?

Acute necrotizing ulcerative gingivitis (ANUG; 'trench mouth') is a fairly common oral disease of complex cause that occurs in normal individuals. Contributing factors include the fusospirochetal oral flora, reduced host resistance, malnutrition, poor oral hygiene, smoking, and psychologic stress.

What happens if ANUG is not treated?

If ANUG is not properly treated the first time you have it, you're more likely to get it again. This can cause persistent bad breath (halitosis) and bleeding gums, as well as gradually receding gums. In rare cases, ANUG can lead to gangrene affecting the lips and cheeks.

What medication is used to treat ANUG?

In patients with ANUG, treatment involves antibiotics, NSAIDs, and topical Xylocaine for pain relief. Saline rinses can help to speed resolution, and oral rinses with a hydrogen peroxide 3% solution also may be of benefit.

What bacteria causes NUG?

The microbiota composition associated with NUG and found in lesion layers includes Treponema spp., Selenomonas spp., Fusobacterium spp., and Prevotella intermedia. Other microorganisms have also been described, although these were defined as “variable” flora and were not present in all cases (Loesche et al. 1982).

Why is ANUG called trench mouth?

Trench mouth is an infection that causes swelling (inflammation) and ulcers in the gums (gingivae). The term trench mouth comes from World War I, when this infection was common among soldiers "in the trenches." The appearance of normal teeth varies, especially the molars.

Can bone grow back after gum disease?

Periodontal regeneration is a method of treatment to get bone to grow back again around a tooth after bone & ligament loss caused by gum disease. It is particularly successful for some types of bone cavities. The main aim is to restore the tooth to its original state before the damage occurred.

Do you give antibiotics for ANUG?

For signs of systemic involvement, the recommended antibiotics are amoxicillin and metronidazole. If left untreated, ANUG may lead to rapid destruction of the gums and can even spread, as necrotizing stomatitis or noma, into the cheeks, lips or jaw.

Does ANUG need antibiotics?

The good news is ANUG can be treated and completely reversed if caught early. In addition to plaque removal, the dentist or periodontist (a specialist in the treatment of gum disease) may prescribe antibiotics along with an antibacterial mouthrinse to reduce bacteria levels in the mouth.

What foods should be avoided with periodontal disease?

It's best to avoid or limit acidic items. Almost all sugary items are bad news for your teeth and gums. Sugary items promote the overgrowth of harmful bacteria in the mouth, worsening gum recession or causing decay. Avoid donuts, candy, energy drinks, cake, and chocolate.

Does ANUG cause bone loss?

ANUG is characterized by marginal gingival necrosis, gingival bleeding and painful ulceration of the gingival surface (1,2). ANUG is caused by periodontopathic bacteria, mainly spirochetes and oral anaerobes (2,3). As ANUG progresses, extensive bone loss can develop, so this is a serious and notable disease.

What stage of gum disease causes bone loss?

In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out.

What vitamin is good for bone loss in teeth?

Adequate vitamin D and calcium make bones and teeth denser and far stronger, which helps prevent fractures and cracks. You can find vitamin D in eggs, fish and dairy products like cheese and fortified milk.

When is it too late for gum grafting?

In some cases, it may be too late for gum grafting to save the gums. If your gums are severely damaged, receding so far back that they expose the tooth's root, or if there is significant bone loss from advanced gum disease, gum grafting may not be able to restore them to their healthy state.

How do you prevent ANUG?

Prevention of Trench Mouth or ANUG

Maintain good oral hygiene . Regular dental check-up and cleans , preferably every six months. Reduce stress. Avoid irritants such as smoking and hot or spicy foods.

What is the initial treatment of necrotizing ulcerative gingivitis?

Treatment is gentle debridement, improved oral hygiene, mouth rinses, supportive care, and, if debridement must be delayed, antibiotics. Acute necrotizing ulcerative gingivitis (ANUG) occurs most frequently in smokers and debilitated patients who are under stress.

What is the management of NUG?

How do you treat ANUG at home?

At home, people are instructed to rinse with salt water, a hydrogen peroxide solution (ordinary drugstore hydrogen peroxide mixed half-and-half with water), or chlorhexidine (an antiseptic). Rinsing may be recommended instead of brushing for the first few days because of the sensitivity of the gums.

How do you diagnose ANUG?

NUG diagnosis is based on three essential symptoms: sore gums, bleeding gums and the most diagnostic characteristic, ulceration and necrosis of the interdental papillae.