Acute necrotising ulcerative gingivitis

Overview Of Acute necrotising ulcerative gingivitis

Acute necrotizing ulcerative gingivitis (ANUG), also known as **trench mouth** or **Vincent's infection**, is a severe and painful form of gum disease characterized by the rapid onset of necrosis (tissue death) of the gingival tissues. It is caused by an overgrowth of opportunistic bacteria, particularly *Fusobacterium* and *Prevotella* species, in the oral cavity. ANUG is often associated with poor oral hygiene, stress, smoking, malnutrition, and immunosuppression. Symptoms include painful, bleeding gums, ulceration, foul breath (halitosis), and a metallic taste in the mouth. If left untreated, ANUG can progress to involve deeper tissues, leading to acute necrotizing ulcerative periodontitis (ANUP). Prompt diagnosis and treatment are essential to prevent complications and restore oral health.

Causes of Acute necrotising ulcerative gingivitis

• ANUG is caused by an imbalance in the oral microbiome, leading to the overgrowth of pathogenic bacteria. Key contributing factors include:
• Poor Oral Hygiene: Inadequate brushing and flossing allow bacterial plaque to accumulate, creating an environment conducive to infection.
• Stress: Physical or emotional stress can weaken the immune system, increasing susceptibility to infection.
• Smoking: Tobacco use impairs blood flow to the gums and reduces immune response, promoting bacterial growth.
• Malnutrition: Deficiencies in vitamins (e.g., vitamin C) and minerals can compromise gum health and immune function.
• Immunosuppression: Conditions such as HIV/AIDS or the use of immunosuppressive medications increase the risk of ANUG.
• Preexisting Gingivitis: Untreated gingivitis can progress to ANUG under favorable conditions. Understanding these causes helps in implementing preventive measures and effective treatment.

Risk Factors of Acute necrotising ulcerative gingivitis

• Several factors increase the risk of developing ANUG, including:
• Poor Oral Hygiene: Inadequate brushing and flossing allow bacterial plaque to accumulate.
• Smoking: Tobacco use is a significant risk factor due to its effects on gum health and immunity.
• Stress: Physical or emotional stress can weaken the immune system.
• Malnutrition: Deficiencies in vitamins (e.g., vitamin C) and minerals compromise gum health.
• Immunosuppression: Conditions such as HIV/AIDS or the use of immunosuppressive medications.
• Preexisting Gingivitis: Untreated gingivitis can progress to ANUG.
• Young Adults: ANUG is more common in individuals aged 15–30 years. Identifying these risk factors can aid in prevention and early intervention.

Prevention of Acute necrotising ulcerative gingivitis

• Preventing ANUG involves maintaining good oral hygiene and addressing risk factors. Key preventive measures include:
• Regular Brushing and Flossing: Brushing twice daily and flossing to remove plaque.
• Routine Dental Check-Ups: Regular visits to the dentist for cleanings and early detection of gum disease.
• Smoking Cessation: Quitting tobacco use to improve gum health and immune function.
• Stress Management: Techniques such as exercise, meditation, or counseling to reduce stress.
• Balanced Diet: Ensuring adequate intake of vitamins and minerals to support gum health.
• Hydration: Drinking plenty of water to maintain oral moisture and reduce bacterial growth. These strategies can significantly reduce the risk of developing ANUG.

Prognosis of Acute necrotising ulcerative gingivitis

• The prognosis for ANUG is generally good with timely diagnosis and treatment. Most patients experience significant improvement within a few days of starting therapy, with complete resolution of symptoms within 1–2 weeks. However, untreated or recurrent ANUG can lead to complications such as chronic periodontitis or systemic infections. Regular follow-up with a dentist and adherence to oral hygiene practices are essential for preventing recurrence and maintaining oral health.

Complications of Acute necrotising ulcerative gingivitis

• Untreated or poorly managed ANUG can lead to several complications, including:
• Chronic Periodontitis: Progression to chronic gum disease, leading to tooth loss.
• Acute Necrotizing Ulcerative Periodontitis (ANUP): Spread of infection to deeper periodontal tissues and bone.
• Systemic Infections: Rarely, bacteria from ANUG can enter the bloodstream, causing infections in other parts of the body.
• Tooth Loss: Severe gum and bone damage can result in loose or lost teeth.
• Psychosocial Impact: Chronic pain, halitosis, and tooth loss can lead to anxiety, depression, or social isolation. Prompt treatment and follow-up can help minimize these complications.

Related Diseases of Acute necrotising ulcerative gingivitis

• ANUG is closely related to several other oral and systemic conditions. These include:
• Gingivitis: Inflammation of the gums, often a precursor to ANUG.
• Chronic Periodontitis: A more advanced form of gum disease involving bone loss.
• Oral Thrush: A fungal infection caused by *Candida*, which can coexist with ANUG.
• Herpetic Gingivostomatitis: A viral infection causing similar ulcerative lesions in the mouth.
• HIV/AIDS: Immunosuppression increases the risk of ANUG and other oral infections.
• Vitamin C Deficiency (Scurvy): Can cause gum bleeding and ulceration, mimicking ANUG.
• Leukemia: Can present with oral manifestations similar to ANUG due to immune suppression. Understanding these related conditions aids in differential diagnosis and comprehensive management.

Treatment of Acute necrotising ulcerative gingivitis

The treatment of ANUG focuses on controlling the infection, relieving symptoms, and addressing underlying risk factors. Key interventions include: 1. **Professional Dental Cleaning**: Removal of plaque and necrotic tissue through scaling and debridement. 2. **Antibiotics**: - **Metronidazole**: The first-line antibiotic for ANUG, effective against anaerobic bacteria. - **Amoxicillin**: An alternative for patients allergic to metronidazole. 3. **Antiseptic Mouthwashes**: Chlorhexidine or hydrogen peroxide rinses to reduce bacterial load. 4. **Pain Management**: Over-the-counter pain relievers such as ibuprofen or acetaminophen. 5. **Hydration and Nutrition**: Ensuring adequate fluid intake and a balanced diet to support healing. 6. **Lifestyle Modifications**: - Smoking cessation. - Stress management techniques. - Improved oral hygiene practices, including regular brushing and flossing. Early and aggressive treatment can lead to complete recovery and prevent recurrence.