What is Acute Necrotizing Ulcerative Gingivitis?
Acute necrotizing ulcerative gingivitis (ANUG) is a rare infection affecting less than 1% of people, which harms the gum tissue between teeth. It often appears suddenly and involves painful sores and swelling of the gums. Even though not many people get this disease, it has great importance because it is the most severe condition related to dental plaque buildup. If ANUG isn’t treated, it can quickly destroy tissue, evolve into a more serious disease known as necrotizing ulcerative periodontitis (NUP), or even progress to a typically fatal condition called cancrum oris (also known as noma). Each case of ANUG is treated uniquely, often considering multiple factors. The approach depends on the severity of the infection and the patient’s ability to withstand the treatment.
What Causes Acute Necrotizing Ulcerative Gingivitis?
ANUG, or acute necrotizing ulcerative gingivitis, is typically caused by specific types of bacteria becoming opportunistic and infecting the gum tissue. The main culprits are usually fusiform bacteria and spirochete bacteria. Some research has identified spirochetes, along with other Gram-negative bacteria including Bacteroides intermedius and Fusobacterium spp., as the most common causes of ANUG.
Another study indicated that the group of microbes associated with ANUG can also include bacteria such as Treponema spp., Selenomonas spp., Fusobacterium spp., and Prevotella intermedia. In short, ANUG tends to result from the activities of spirochetes and Gram-negative bacteria. These bacteria can be identified using a type of lab test called a gram stain, if carried out.
Risk Factors and Frequency for Acute Necrotizing Ulcerative Gingivitis
ANUG, also known as acute necrotizing ulcerative gingivitis, has been known about since around the fourth century BC. Historically, it has been particularly common among military troops, and studies show this trend continuing today. It’s often seen in young people, notably in severely malnourished children and young adults suffering from HIV. In the United States, ANUG seems to mainly affect the white population. Studies have also shown that certain factors increase the risk of developing ANUG. These include difficulties in managing stress, a weakened immune system, and tobacco use.
- ANUG has been recorded as early as the fourth century BC.
- It continues to be commonly seen among military forces.
- Young, severely malnourished children and young adults with HIV are particularly at risk.
- In the U.S., ANUG mostly affects the white population.
- Stress, a weakened immune system, and tobacco use are strongly associated with developing ANUG.
Signs and Symptoms of Acute Necrotizing Ulcerative Gingivitis
Acute Necrotizing Ulcerative Gingivitis (ANUG) is diagnosed primarily through a physical exam. Key indications of this condition are mouth pain that comes on quickly, gum bleeding, and ulcers or tissue decay between the teeth. Sometimes there might be additional symptoms like swollen glands, feeling unwell, foul breath, and the formation of a false membrane on the gums. Some factors make people more likely to develop ANUG, including.
- Poor oral hygiene
- Weakened immune system, especially in people with HIV
- Nutrient deficiencies
- Poor living conditions
- Stress
Testing for Acute Necrotizing Ulcerative Gingivitis
To diagnose Acute Necrotizing Ulcerative Gingivitis (ANUG), often called gum infection, doctors typically rely on a thorough review of your medical history and a physical examination. Although a microscopic analysis of the gum tissue (known as a gram stain) can enhance the diagnosis, it’s not always necessary and is not conducted in all cases.
Treatment Options for Acute Necrotizing Ulcerative Gingivitis
The treatment of ANUG, a painful type of gum disease, is a multi-step process that includes treating the immediate symptoms, addressing any existing conditions, dealing with any aftereffects, and then moving into a maintenance phase to prevent relapse.
In the initial stage, the treatment aims to stop the damage to the gums and help control the patient’s pain. This involves gently removing plaque and hard deposits on the gums with an ultrasonic tool and applying localized oxygen therapy to the damaged areas. Consider using a mouth rinse containing 0.12% chlorhexidine gluconate twice a day for a month. Systemic antibiotics might be needed if the initial treatment doesn’t work or if the patient shows signs of a systemic infection like fever or vomiting.
Metronidazole, taken three times a day, is a commonly prescribed first-choice antibiotic because it’s effective against the type of bacteria commonly involved in ANUG. Other antibiotics such as penicillin, tetracyclines, clindamycin, amoxicillin, and amoxicillin with clavulanate can also be effective and might be used based on individual patient factors. For instance, in one study, oral penicillin led to significant improvement in three to six days. Topical antimicrobials aren’t recommended, however, because the large number of bacteria present may interfere with their effectiveness. Patients with weakened immune systems who are on antibiotics should also get antifungal medicines.
Once the acute phase of ANUG has been managed, any previously existing conditions such as chronic gingivitis should be treated. This involves professional teeth cleaning and teaching the patient how to maintain good oral hygiene at home. Factors that can contribute to ANUG, like smoking, inadequate sleep, and stress, should be addressed. Any resulting superficial craters can be treated with gum surgery.
The focus of the maintenance phase is to keep up good oral hygiene practices and manage any lifestyle factors that could lead to a relapse. If maintenance isn’t maintained, then the disease is likely to come back.
In sum, treating ANUG involves a combination of methods: gently removing plaque and hard deposits, educating about good oral hygiene, using mouthwash and oral antibiotics, starting a thorough dental cleaning plan, and managing risk factors.
What else can Acute Necrotizing Ulcerative Gingivitis be?
When a doctor is trying to diagnose ANUG, a type of gum disease, there are other conditions that may cause similar symptoms. This can make it confusing to determine what exactly is causing the problem. These potentially similar conditions might include:
- Strep throat or gonorrhoea, both of which can cause gum inflammation
- Acute herpetic gingivostomatitis, another mouth infection common in kids
- Infectious mononucleosis, more commonly known as mono
- Pattern baldness of the gums, medically known as desquamative gingivitis
- Erythema multiforme, another skin and mucous membrane disorder
- Pemphigus vulgaris, a rare skin blistering condition
It’s also important to note that doctors should consider ANUG as a possibility in people living with HIV, even if their CD4+ T-lymphocyte counts (a type of white blood cell that’s part of the immune system) are stable.
What to expect with Acute Necrotizing Ulcerative Gingivitis
With the right treatment, the disease usually doesn’t get worse and the ulcer can typically heal in a few days. However, if the condition isn’t treated, it could worsen and result in severe and even life-threatening conditions like necrotizing ulcerative periodontitis (NUP) and cancrum oris (noma).
Possible Complications When Diagnosed with Acute Necrotizing Ulcerative Gingivitis
Acute necrotizing ulcerative gingivitis is a serious condition that can result in severe tissue damage. This damage can develop into more serious illnesses like necrotizing periodontitis, necrotizing stomatitis, and cancrum oris (also known as “noma”). Noma is often fatal. Recognizing and treating these conditions can be difficult, but it’s crucial for medical practitioners who treat both adults and children.
Preventing Acute Necrotizing Ulcerative Gingivitis
Healthy gums are crucial for overall health. The best way to avoid serious gum diseases like gingivitis is to maintain good oral hygiene. This involves brushing your teeth twice a day, flossing or cleaning between your teeth daily, and seeing your dentist on a regular basis.
Health problems such as HIV, diabetes, and cancer might impair your ability to fight infections, increasing the likelihood of getting gum disease. Certain medications, like those for seizures or high blood pressure, hormonal changes, and tobacco use can all affect your gum health as well. Therefore, it’s especially important for pregnant individuals and those living with these conditions to regularly see a dentist.
Remember, keeping your gums healthy and prevent diseases is achievable through daily oral care and routine dentist visits.
