Search
acute necrotizing ulcerative gingivitis; Vincent's angina; trenchmouth; cancrum oris novum; fusospirochetosis (ANUG)
Sudden inflammation of the gingivae with necrosis, pain, bleeding & halitosis.
Etiology:
1) Pseudomonas intermedia
2) spirochetes, especially Borrelia vincenti
3) anaerobic bacteria in patients with AIDS
Epidemiology:
1) often occurs after a debilitating illenss
2) occurs in malnourished children in underdeveloped countries
3) occurs as a complication of leukemia
4) occurs in patients with genetic deficiency of catalase
5) AIDS
Clinical manifestations:
1) halitosis
2) excessive salivation
3) ulceration & necrosis of tonsils & gingiva
- may create pseudomembrane that bleeds if scraped [2]
4) bleeding gums
5) bad taste
6) cervical lymphadenopathy
7) patients may be systemically ill
a) fever
b) leukocytosis
Complications:
1) infection may spread to buccal mucosa, mandible or maxilla
2) tissue destruction (necrosis)
Management:
1) antibacterial mouth rinses (mouthwash)
2) debridement
3) systemic antibiotics
a) penicillin
b) metronidazole 250 mg PO TID (anaerobes)
c) clindamycin 300 mg PO TID (anaerobes)
d) amoxicillin clavulanate 250 mg PO TID
e) antipseudomonal agent if Pseudomonas is suspected
General
gingivitis
bacterial infection
angina
References
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 200, 201, 518, 701
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022