Acute necrotizing ulcerative periodontitis


Acute necrotizing ulcerative periodontitis (ANUP) is a special form of periodontitis that usually results from acute necrotizing ulcerative gingivitis (ANUG). In acute necrotizing ulcerative periodontitis not only the gums are affected, as in gingivitis, but especially the periodontium. It is a rapidly progressing inflammation accompanied by acute pain, which leads to tissue decay (necrosis) and ulceration at the very beginning of the disease.


It is a mixed infection of different strains of bacteria, including Fusobacteria, Treponema and Selenomonas strains, as well as the bacteria Prevotella intermedia and Porphyromonas gingivalis. Necrotizing ulcerative periodontitis originates from necrotizing ulcerative gingivitis and its causes include psychological stress, a weakened and poorly functioning immune system, for example in HIV-positive patients, malnutrition, poor oral hygiene and tobacco consumption. In most cases the infection occurs in adolescence or in young adults, but a late infection in patients at an advanced age cannot be excluded.


Because of the acute pain and the rapid progression of the inflammation, a dentist should be consulted at the first signs. This dentist can already recognize and treat typical symptoms of necrotizing ulcerative periodontitis during the first inspection of the oral cavity. A laboratory examination can also provide information about the bacterial strains and, if necessary, enable targeted treatment. This topic might also be of interest to you: Acute necrotizing ulcerative gingivitis

These symptoms may indicate acute necrotizing ulcerative periodontitis

In necrotizing ulcerative periodontitis, the inflammation spreads to all structures of the periodontium. Necrosis of the gums and bone occurs. Initially, there is severe necrosis of the gum papillae up to interdental craters and exposed bone.

This is accompanied by bleeding and severe pain. The initial pain is an essential distinguishing feature compared to other periodontal diseases, as these are usually painless. Poor oral hygiene leads to greyish-yellowish plaque on the oral mucosa.

This leads to the formation of ulcers (ulceration). In most cases, this leads to a foul or metallic taste in the mouth and to bad breath. General medicine may cause fever and inflamed lymph nodes.

All in all, the general state of health is poor. The symptoms need not all be present and depend on the extent and severity of the illness. The pain makes it very difficult to eat, and oral hygiene is also not easy to perform, which further worsens the general condition and further promotes the progression of the inflammation in the mouth.


The therapy of necrotizing ulcerative periodontitis consists of two parts. Acute therapy includes the removal of germs to prevent the inflammation from spreading further and thus to curb the disease activity. First of all, the pain should be reduced so that adequate oral hygiene is possible again.

Under local anesthesia, the dentist will remove the plaque and then use disinfectant rinses (e.g. CHX®). The plaque is removed thoroughly either with hand instruments such as curettes or with ultrasonic instruments. The additional local use of a corticosteroid preparation (e.g. Dontisolon®) also helps to prevent the release of tissue-dissolving messengers and enzymes.

As a second point of therapy, additional therapy with antibiotics (e.g. penicillin) may be useful, especially if the general condition does not improve even after the previous acute therapy and the symptoms do not become significantly less after 2-3 days. Thorough oral hygiene by the patient at home and regular disinfecting mouth rinses (e.g. CHX®) are very important for a successful healing process. In case of very severe pain at the beginning of the therapy, an analgesic (e.g. Ibuprofen®) can help. Since necrotizing ulcerative periodontitis indicates a weakened, not well-functioning immune system and is one of the early symptoms of some diseases, such as HIV infection, one should also be examined by an internist. Acute therapy is followed by maintenance therapy, which includes regular check-ups and thorough tooth cleaning.