Definition
Acute Necrotizing Ulcerative Gingivitis is a polymicrobial, endogenous infection.
Causes of acute necrotizing ulcerative gingivitis
This condition is caused by Fusiform and spirochaete bacteria.
Epidemiology
- In developing countries, seen almost exclusively in children
- Related to poverty and malnutrition (predisposing factors)
- In industrialized countries, most common in young adults with neglected mouths; smoking and stress have been associated
Symptoms and clinical features of acute necrotizing ulcerative gingivitis
- Crater ulcers striating at the tips of the interdental papillae
- Ulcers spread along gingival margins
- Gingival soreness and bleeding
- Foul breath
- Metallic taste
- Increased salivation
- Cervical lymphadenopathy and fever in advanced cases
Differential diagnoses
- Primary herpetic gingivo-stomatitis
- HIV-associated acute ulcerative gingivitis
- Gingival ulceration in acute leukaemia or aplastic anaemia
Investigations
Smears from ulcers show predominantly
spirochaetes and gram-negative fusiform
bacteria
Treatment for acute necrotizing ulcerative gingivitis
Treatment objectives
- Treat infection
- Restore oral health
Non-drug treatment
Oral hygiene (debridement) is essential
Drug treatment
Metronidazole
Adult: 200 mg orally 8 hourly for 3 days 3 days;
Child:
- 1-3 years: 50mg orally every 8 hours for 3 days
- 3-7 years: 100mg every 12 hours;
- 7 – 10 years: half adult dose
Supportive therapy
Ascorbic acid
Adult: not less than 250 mg orally daily (in divided doses)
Child:
- 1 month – 4 years: 125 – 250 mg in 1 to 2 divided doses
- 4-12 years: 250-500 mg daily in 1 to 2 divided doses;
- 12-18 years: 500 mg – 1 g daily in 1 – 2 divided doses
Ferrous sulfate
Adult: 200 mg orally three times daily taken before food
Child:
- 6-12years: half adult dose
Follow-up treatment
- Rehabilitation of the mouth
- Once the acute phase has subsided, oral hygiene should be brought to as high a standard as possible to lessen the risk of recurrence
- Sequestrectomy
Adverse drug reactions
- Metronidazole: nausea, vomiting,
unpleasant taste; disulfiram-like effect with alcohol.