In acute necrotizing ulcerative gingivitis (ANUG), the gums are severely reddened and swollen. Tissue decay (necrosis) occurs quite early. The inflammation often causes severe pain, which makes food intake difficult and makes adequate oral hygiene impossible. As the inflammation spreads further, the disease often turns into acute necrotizing ulcerative periodontitis (ANUP). Particularly at the beginning of the disease, poor well-being and fever often occur.
Causes of ANUG
Acute necrotizing ulcerative gingivitis (ANUG) is a mixed infection of various strains of bacteria, including Fusobacteria, Treponema and Selenomonas. However, the presence of certain risk factors is largely responsible for the development of this disease: with perfect oral hygiene, the pathogens would not be able to spread as far and thus the possibility of destroying the tissue is removed. This is why it is so important to clean the teeth thoroughly – bacteria also like to romp around in the spaces between the teeth. – poor oral hygiene
- Nicotine consumption
- Psychological stress
- Nutritional deficiency symptoms
- Weakened immune system, for example in HIV-positive patients
These symptoms may indicate ANUG
The disease often occurs suddenly and can be accompanied by fever. At the onset of the disease, the gums swell and gum bleeding and acute pain may occur. Already in the early course of the disease necrosis, i.e. the death of tissue, and the characteristically punched out appearance of the gum papillae occur.
In addition, ulcers (ulceration) form on the edge of the gums, which can appear greyish. Yellowish plaque is also frequently found on the oral mucosa, which is due to a lack of oral hygiene. In most cases, this results in a foul or metallic taste in the mouth and bad breath. In general medicine, it can also lead to inflamed lymph nodes and a general feeling of illness.
Diagnosis of an ANUG
Due to the rapid progression of the inflammation, early treatment by the dentist is advisable. A clinical examination of the oral cavity can often provide a clear diagnosis. In addition, a laboratory examination can be helpful in order to enable a targeted drug treatment.
During the laboratory examination, the various strains of bacteria can be determined. Since acute necrotizing ulcerative gingivitis often occurs in connection with general medical diseases, one should also have a check-up by an internist. A referral is helpful here.
Handling of an ANUG
Due to the pain, domestic oral hygiene is very limited, so a soft toothbrush should be used to clean your teeth. Early treatment by the dentist is important. After the diagnosis, the dentist will remove the inflamed tissue with a hand scaler, a curette or an ultrasonic instrument.
Subsequent rinsing with saline solution or chlorhexidine can be supportive. Chlorhexidine reduces the bacterial load and can also be used at home. However, care should be taken not to rinse excessively and chlorhexidine should not be used for more than one week at a time, as this can lead to impaired taste and discolouration of the teeth and tongue, which can, however, be removed as part of a professional tooth cleaning procedure Since acute necrotizing ulcerative gingivitis is a bacterial infection, taking an antibiotic (e.g.
Amoxicillin® or Erythromycin®) can also help to provide rapid relief of the acute symptoms Painkillers (e.g. Ibuprofen®) can also help with stronger pain. Other supportive measures include improved oral hygiene and avoiding additional stimuli such as smoking, spicy or hot food and drinks. You should also have an additional examination by an internist, as acute necrotizing ulcerative gingivitis could also indicate general medical conditions and infections such as HIV.
Antipyretic drugs can be administered to reduce the initial fever. After treatment by the dentist and removal of the inflammatory tissue, in most cases there is a significant improvement after 24 to 48 hours. Thorough oral hygiene and regular rinsing can shorten the healing process and have a positive effect. Nevertheless, the time required for complete healing of acute necrotizing ulcerative gingivitis varies from patient to patient and also depends on the severity of the disease and the patient’s general health condition.