Acute necrotizing ulcerative gingivitis, also shortened to ‘ANUG’ is an infection of the gums or gingiva. The clinical picture of a patient with ANUG is typically of inflamed gums with crater like depressions and sloughing. As the name suggests, it involves necrosis (dying out) of gum tissue. The disease usually presents as acute, but without treatment it may transform in a sub-acute form with milder symptoms. It can spread to involve widespread parts of the mouth and it can also be limited to a number of teeth or around single tooth. If the condition is not treated, especially in patients with low immunity it can also cause bone loss of the bone surrounding the tooth. It is then referred to as Acute necrotizing ulcerative periodontitis.
Etiology of ANUG and the predisposing factors
Acute necrotizing ulcerative gingivitis is very closely related to lowered immunity in the patient. It sometimes appears after an episode of a respiratory tract infection or of any other debilitating disease. Safe to say, it is not a disease that a healthy person may acquire.
Any local irritating factors like an impinging overhanging restoration, or part of a tooth traumatizing the mucosa on opposing tooth etc also predispose the patient to this condition. Smoking also increases the chances of it.
Systemic factors that can predispose to ANUG are many, like debilitating diseases (diabetes, anemia, leukemia, cancer etc.), nutritional deficiencies (Vitamin B,C) and stress and restlessness.
What are the signs and symptoms of ANUG?
Due to its characteristic signs and symptoms, Acute necrotizing ulcerative gingivitis is diagnosed only with the clinical features.
Clinically, the lesion presents as crater like depression on the gingiva between teeth, called interdental papilla. It then extends to involve the rest of the gums gradually. The lesion is covered by a kind of membrane that is grayish in color. There is redness around the lesion that demarcates it from the rest of the healthy gum tissue. In some cases the membrane may not be present and the underlying lesion can be seen as red and shiny, that bleeds easily. The lesion can be destroying underlying tissue, even progressing as far as to destroy bone. Patient experiences excessive, thick saliva production and a fetid odour coming from the mouth. The lesion bleeds upon slightest stimulation or insult, at times even without it spontaneously.
The person also experiences a gnawing pain that radiates to other parts of the mouth and a metallic taste in the mouth. Pain can worsen on eating certain food like spicy food or just chewing.
Systemic signs and symptoms are usually not present but if they are, the may include fever, loss of apetite, insomnia, constipation etc.
Treatment of Acute Necrotizing Ulcerative Gingivitis
Treatment needs to cover two things:
- Alleviation of the acute symptoms like pain
- Treatment of any underlying gum disease
The orderly sequence of ANUG’s treatment consists of 3 visits to the dental clinic. The first visit involves a complete evaluation and examination of the patient to determine the cause, predisposing factors, aggravating factors and extent of the condition. The lesions are cleaned and disinfected by the dentist as much as possible without excessively causing the patient any pain. Ultrasonic scaling may be needed of tooth deposits are too many. Patient is then placed on a regimen of antibiotics, pain killers and anti-pyretics (in case of fever).
The second visit is almost 2 days after the first one. By which patient’s discomfort and symptoms have reduced significantly. The third visit is 5 days after the second one. He/she is evaluated again and further management is done according to the individual case.
The patient is directed not to smoke during the course of treatment and to avoid spicy foods. He or she is also prescribed appropriate mouthwashes or rinses to help keep the oral environment as clean as possible.