Acute Necrotizing Ulcerative Gingivitis

Make a presumptive clinical diagnosis when there is acute onset of intense gingival pain, spontaneous bleeding, and punched-out necrosis or ulceration of one or more interdental papillae. A gray pseudomembranous surface, fetid breath, excessive salivation, and regional symptoms support the diagnosis. BMJ+3BMJSystematic scoping review of the noma evidence landscapePubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI BookshelfPubMedAcute Necrotizing Ulcerative Gingivitis: A Case Report - PMCPubMedNecrotizing Ulcerative Gingivitis

Assess the extent of disease at the first examination. Disease confined to gingiva is consistent with necrotizing gingivitis; tooth loosening, periodontal attachment or osseous involvement, or extension beyond gingiva should prompt urgent dental-periodontal evaluation for more extensive necrotizing periodontal disease or stomatitis. Radiographic bone loss around teeth or implants has been reported with necrotizing ulcerative gingivitis-periodontitis. WHO+2WHOHIV/AIDSWHOPresumptive and definitive criteria for recognizing HIV- ...PubMedNecrotizing Ulcerative Gingivitis, a Rare Manifestation as a ...

Escalate urgently when the patient has fever, malaise, lymphadenopathy, rapidly spreading oral necrosis, inability to maintain oral intake, or major host-defense impairment. Children receiving chemotherapy with severe neutropenia and thrombocytopenia can deteriorate rapidly despite local measures and broad-spectrum antibiotics; reported progression included sepsis and death. ScienceDirect+1ScienceDirectAcute Necrotizing Ulcerative Gingivitis - an overviewScienceDirectACUTE NECROTIZING ULCERATIVE GINGIVITIS IN ONCOPEDIATRIC PATIENTS: CHALLENGES IN TREATMENT - ScienceDirect

The diagnostic triad is rapid onset of gingival pain, interdental papillary necrosis, and bleeding. Pseudomembrane formation and halitosis strengthen the diagnosis, but neither substitutes for careful inspection of the gingival margin and papillae. PubMed+2PubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI BookshelfPubMedAcute Necrotizing Ulcerative Gingivitis: A Case Report - PMCPubMedNecrotizing Ulcerative Gingivitis

Do not obtain routine lesion culture to establish ANUG. The lesion microbiota may include Treponema, Selenomonas, Fusobacterium, and Prevotella species, but similar organisms can be detected in healthy and other periodontal sites; therefore microbiologic testing does not provide useful diagnostic discrimination. IDSA/ASM guidance lists Gram stain as a potential diagnostic procedure for Vincent angina but does not recommend culture; if sampling is attempted, use biopsy or irrigation/aspirate rather than a swab. PubMed+1PubMedNecrotizing Ulcerative GingivitisPubMedA Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology - PMC

Pursue an alternate diagnosis when the lesion distribution or associated findings do not fit papillary necrosis. Acute herpetic gingivostomatitis and infectious mononucleosis are important viral mimics; gonococcal and streptococcal gingivitis are bacterial considerations. Desquamative gingivitis, erythema multiforme, and pemphigus vulgaris should enter the differential when diffuse desquamation, broader mucocutaneous involvement, or persistent atypical erosions predominate. PubMed+1PubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI BookshelfPubMedNecrotizing Ulcerative Gingivitis

Arrange superficial debridement, generally under local anesthesia when needed, as the acute procedural cornerstone. Acute management also includes oral-hygiene instruction and antimicrobial mouthwash; chlorhexidine, warm saltwater, or diluted hydrogen peroxide rinses are described local adjuncts. Reassess after acute inflammation improves for further debridement and comprehensive periodontal evaluation. ScienceDirect+1ScienceDirectAcute Necrotizing Ulcerative Gingivitis - an overviewPubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI Bookshelf

Use systemic antibiotics as an adjunct when the patient is immunocompromised or has systemic signs such as fever, malaise, or lymphadenopathy. Metronidazole or penicillin are described treatment options; an American Academy of Pediatrics reference similarly identifies debridement with penicillin or metronidazole as management. Available evidence does not establish a source-supported adult dosing regimen in this record, so coordinate agent selection and dosing with the treating dentist or oral specialist and patient-specific factors. ScienceDirect+2ScienceDirectAcute Necrotizing Ulcerative Gingivitis - an overviewpublications aap86: Common Oral LesionsPubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI Bookshelf

Provide analgesia sufficient to permit hydration, nutrition, and oral hygiene. Recommend rest, fluid intake, and a soft nutritious diet during the acute episode, and address tobacco exposure because recurrence prevention depends on restoring hygiene and reducing predisposing exposures. ScienceDirect+1ScienceDirectAcute Necrotizing Ulcerative Gingivitis - an overviewPubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI Bookshelf

Review the exposure pattern that contributed to disease: poor oral hygiene, tobacco use, malnutrition, psychological stress, inadequate sleep, unsanitary living conditions, and immunocompromise are recognized predisposing factors. A focused plan should specify periodontal follow-up, daily plaque control, nutritional support when indicated, tobacco cessation, and management of systemic immunosuppression. PubMed+2PubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI BookshelfPubMedNecrotizing Ulcerative GingivitisPubMedNecrotizing ulcerative gingivitis, periodontitis, and stomatitis

Maintain periodontal follow-up after the acute episode. The maintenance phase is intended to reinforce oral-hygiene adherence and control predisposing factors; relapse is likely when maintenance is not performed. PubMedPubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI Bookshelf

When ANUG occurs without an obvious local explanation, particularly in a young adult or patient with recurrent disease, evaluate for HIV and other causes of impaired host defense. ANUG is among oral manifestations recognized in HIV, and clinicians should consider it even with stable CD4+ counts. Nature+3NatureExpert consensus on endodontic therapy for patients with systemic conditions | International Journal of Oral ScienceWHOHIV/AIDSWHOPresumptive and definitive criteria for recognizing HIV- ...PubMedAcute Necrotizing Ulcerative Gingivitis - StatPearls - NCBI Bookshelf