Acute ulcerative gingivitis

gum disease causes bleeding


Acute ulcerative gingivitis (AUG) has had many names over the years, Vincent's Disease, Acute necrotizing ulcerative gingivitis (ANUG), Necrotizing ulcerative gingivitis (NUG), FusoSpirochetal gingivitis and trench mouth (due to prevalence in the First World War).


  • Rapid onset
  • Intense pain in the gums
  • Bleeding in the gums
  • Gum necrosis (characteristic punched out appearance of gums)
  • Bad taste and bad breath
  • Sometimes patients have swollen/painful lymph glands
  • Sometimes patients also develop fever/malaises

Home care advice

Dentists are very busy and a scale and polish appointment may take a while to get, so you have to try and clean your teeth as well as you possibly can. The gums can be extremely sore so you might need an anaesthetic gel to numb the gums while cleaning.

  • Wipe away and sloughing (dead) bits of gum with cotton wool soaked in a hydrogen peroxide mouthwash 
  • Clean your teeth as thoroughly as possible, ideally with an electric toothbrush twice a day
  • Clean between your teeth with interdental brushes or dental floss every evening
  • Use a chlorhexidine based mouthwash or gel twice a day (ideally at another time or day to regular tooth brushing)
  • Pain can be relieved by Ibuprofen and paracetamol
  • If you have fever/malaise 

NB Do not use Ibuprofen if you have symptoms of Covid19 or if you have any medical conditions which contraindicate the use of NSAIDs. Always read the label


Risk Factors

  • Poor oral hygiene
  • Smoking
  • Stress
  • Nutritional deficiencies
  • Immunodeficiency ( eg HIV infection, Immunosupressant )


  • Thorough cleaning under local anaesthesia
  • Clean sloughing gums using cotton wool dipped in chlorhexidine or hydrogen peroxide
  • Provide patient with specific oral hygiene instructions to use a prescription antibacterial mouthwash: chlorhexidine 0.12% twice daily
  • Control pain with analgesics: ibuprofen
  • Improve nutrition, mouth care, fluid intake, and STOP SMOKING
  • Antibiotics (Amoxycillin or Metronidazole) may be required if there is fever or malaise or in immunocompromised patients
  • Follow up with a comprehensive periodontal evaluation after resolution of the acute condition
Written by Andrew Bain BDS MJDF (RCS Eng)
Apr 27, 2020