Acute ulcerative gingivitis

Summary

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).

Features

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

Causes

Risk Factors

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

Treatment

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