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2.1
Necrotizing Ulcerative Gingivitis
Gingivitis Necrotizing Ulcerative

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WIKIDATA, Public Domain

Presentation

Three specific clinical characteristics must be present to diagnose NUG, pain (usually of rapid onset) interdental necrosis, and bleeding. [ncbi.nlm.nih.gov]

Immune System

  • Cervical Lymphadenopathy

    Other signs and symptoms include malaise, fever, cervical lymphadenopathy, and the presence of fusobacteria and oral spirochetes. Occurs rarely in developed areas. [visualdx.com]

    Cervical lymphadenopathy What is the treatment of Vincent's angina? 1. Systemic: High antibiotics, penicillin and its derivatives very effective. 2. Local a. Sodium Perborate paste is spread over the ulcer. [specialist-ent.com]

    Initial signs and symptoms include halitosis; thick, increased oral secretions; bleeding gums; and localized cervical lymphadenopathy. [journals.lww.com]

Entire Body System

  • Pain

    OLS > Experimental Factor Ontology EFO > EFO:1001058 http://www.ebi.ac.uk/efo/EFO_1001058 An acute or chronic GINGIVITIS characterized by redness and swelling, NECROSIS extending from the interdental papillae along the gingival margins, PAIN; HEMORRHAGE [ebi.ac.uk]

    The often severe gingival pain that characterizes ANUG distinguishes it from the more common chronic periodontitis which is rarely painful. [en.wikipedia.org]

    NUG is different from other periodontal diseases in that it presents with interdental necrosis, “punched out” ulcerated papillae, gingival bleeding and pain. [jcda.ca]

    Topic Resources Acute necrotizing ulcerative gingivitis is a painful infection of the gums. Symptoms are acute pain, bleeding, and foul breath. Diagnosis is based on clinical findings. [msdmanuals.com]

    Over-the-counter pain relievers may reduce your discomfort. Soothing rinses or coating agents may reduce pain, especially before eating. You may apply lidocaine to your gums for severe pain. [nlm.nih.gov]

  • Fever

    Often, the lymph nodes under the jaw swell, and a mild fever develops. [msdmanuals.com]

    In some cases, there may be fever and swollen lymph nodes of the head and neck. Dental x-rays or x-rays of the face may be taken to determine how severe the infection is and how much tissue has been destroyed. [nlm.nih.gov]

    A68.0 Louse-borne relapsing fever A68.1 Tick-borne relapsing fever A68.9 Relapsing fever, unspecified A69 Other spirochetal infections A69.0 Necrotizing ulcerative stomatitis A69.1 Other Vincent's infections A69.21 Meningitis due to Lyme disease A69.22 [icd10data.com]

  • Malaise

    It is usually accompanied by systemic signs of fever, malaise and cervical and submandibular lymphadenopathy. It is caused by the profileration of anaerobic bacteria and has been linked to smoking and immunosuppression. [ncbi.nlm.nih.gov]

    […] punched out) of papillae ( Figs. 1 and 2 ) Intense gingival pain Bleeding gingiva with little or no provocation Secondary features: Fetid breath, yellowish-white or grayish slough “pseudomembrane” covering ulcerated papilla, lymphadenopathy, fever and malaise [jcda.ca]

    Other signs and symptoms include malaise, fever, cervical lymphadenopathy, and the presence of fusobacteria and oral spirochetes. Occurs rarely in developed areas. [visualdx.com]

    Symptoms and Signs of ANUG The usually abrupt onset may be accompanied by malaise or fever. [msdmanuals.com]

    Fever and malaise may also be present. Vincent gingivitis can occur after a prolonged failure to brush one’s teeth, though there are many other predisposing factors, such as vitamin deficiencies, emotional stress, and so on. [britannica.com]

Gastrointestinal

  • Choking

    The word "angina" comes from the Latin "angere" meaning "to choke or throttle." [medterms.com]

Jaw & Teeth

  • Poor Oral Hygiene

    The result showed that only 2.4% of the children with good oral hygiene had NUG, compared with: 24.6% of those with fair oral hygiene; 62.8% of those with poor oral hygiene; and 66.7% of those with very poor oral hygiene. [ncbi.nlm.nih.gov]

    Risk factors may include poor oral hygiene, tobacco use, pre-existing oral infection, and a weakened immune system (as from poor nutrition or emotional stress). — called also fusospirochetosis, necrotizing ulcerative gingivitis, trench mouth, Vincent's [merriam-webster.com]

  • Bleeding Gums

    a severe form of gingivitis that is marked especially by painful, bleeding gums with ulcers and is associated with the proliferation of microorganisms (such as the bacteria Fusobacterium nucleatum and Treponema vincentii ) that are normally part of [merriam-webster.com]

    Alerts and Notices Synopsis   Periodontal disease commonly called trench mouth, or Vincent's angina, characterized by painful, erythematous, bleeding gums, malodorous breath, and necrosis and ulceration of connective gum tissue. [visualdx.com]

    NUG diagnosis is based on three essential symptoms: sore gums, bleeding gums and the most diagnostic characteristic, ulceration and necrosis of the interdental papillae. [ncbi.nlm.nih.gov]

    The chief symptoms are painful, swollen, bleeding gums; small, painful ulcers covering the gums and tooth margins; and characteristic fetid breath. The ulcers may spread to the throat and tonsils. Fever and malaise may also be present. [britannica.com]

  • Gingival Ulceration

    As with most poorly understood diseases, Vincent's angina goes by many other names including acute membranous gingivitis, fusospirillary gingivitis, fusospirillosis, fusospirochetal gingivitis, necrotizing gingivitis, phagedenic gingivitis, ulcerative [medterms.com]

    gingivitis, phagedenic gingivitis, ulcerative gingivitis, Vincent stomatitis, Vincent gingivitis, and Vincent infection. [rxlist.com]

  • Halitosis

    ‘Oral cavity conditions that can produce halitosis are dentures, chronic periodontal disease, coated tongue and Vincent's angina.’ [en.oxforddictionaries.com]

    Halitosis/ bad taste which again can be severe. These symptoms are caused by the by-products of the bacteria that eat the gingival tissues – Not pleasant! Ulcers on the gums. [dentalcarematters.com]

    […] slightly Ulceration or necrosis of the papillae or gingival Experience pain while eating food or swallowing Noticeable gray color film on the gums Sore and ulcers (crater-like) in between the gums and the teeth Unpleasant, foully taste in the mouth Halitosis [mytooth.net]

    Symptoms and signs include: Severe deep pain – main symptom Spontaneous bleeding – usual Halitosis (bad breath) – usual Multiple sites of gum necrosis - usual Loss of alveolar bone – usual Pseudomembrane formation – very common Lymph gland enlargement [dermnetnz.org]

    Halitosis ( bad breath ), in which the breath begins to take on a foul odor, may be present in more severe forms of gingivitis. When Should Someone Seek Medical Care for Gingivitis? For simple gingivitis, work with a dentist. [emedicinehealth.com]

  • Bad Taste

    In addition to ulcers, other common symptoms of ANUG include painful gums, bad taste in the mouth, bad breath, mild to severe gum bleeding, a grayish film on the gums, and severe discomfort while eating/swallowing. [diseaseinfosearch.org]

    taste in the mouth; extremely bad breath Red and swollen gums Gray residue on the gums Large ulcers or loss of gum tissue in between teeth Fever Discomfort Swollen lymph nodes Copyright © Nucleus Medical Media, Inc. [health.cvs.com]

    taste in the mouth; extremely bad breath Red and swollen gums Gray residue on the gums Large ulcers or loss of gum tissue in between teeth Fever Discomfort Swollen lymph nodes Red and Swollen Gums Copyright © Nucleus Medical Media, Inc. [winchesterhospital.org]

    Halitosis/ bad taste which again can be severe. These symptoms are caused by the by-products of the bacteria that eat the gingival tissues – Not pleasant! Ulcers on the gums. [dentalcarematters.com]

Skin

  • Ulcer

    […] gingivostomatitis [Ambiguous], acute necrotizing ulcerative gingivitis, Vincent's disease, Vincent's angina, Vincent's Angina, Gingivitis, Necrotizing Ulcerative, acute necrotising ulcerative gingivitis, Vincent's angina NOS, (Vincent's angina) or (trench [ebi.ac.uk]

    […] site acute necrotising ulcerative gingivitis acute necrotising ulcerative gingivitis [Ambiguous] acute necrotising ulcerative gingivostomatitis acute necrotising ulcerative gingivostomatitis [Ambiguous] acute necrotizing ulcerative gingivitis acute necrotizing [wikidata.org]

    Applicable To Fusospirochetal pharyngitis Necrotizing ulcerative (acute) gingivitis Necrotizing ulcerative (acute) gingivostomatitis Spirochetal stomatitis Trench mouth Vincent's angina Vincent's gingivitis The following code(s) above A69.1 contain annotation [icd10data.com]

    Acute necrotizing ulcerative gingivitis (ANUG): This is trench mouth, a progressive painful infection with ulceration, swelling and sloughing off of dead tissue from the mouth and throat due to the spread of infection from the gums. [medterms.com]

    ulcerative gingivitis and in a good nutritional state. [ncbi.nlm.nih.gov]

Workup

Serum

  • Antinuclear Autoantibodies

    It has an acute clinical presentation with the distinctive characteristics of rapid onset of interdental gingival ne… PMC Free PDF PMC Free Full Text FREE Publisher Full Text Clinicopathologic significance of in vivo antinuclear autoantibodies in oral [unboundmedicine.com]

Microbiology

  • Capnocytophaga

    The analyses showed that the fusiform taxa (Fusobacterium nucleatum/Fusobacterium periodonticum, Leptotrichia buccalis, Tannerella forsythensis, and Capnocytophaga sp.), Campylobacter rectus, Prevotella intermedia, Prevotella nigrescens, Selenomonas sputigena [ncbi.nlm.nih.gov]

Treatment

The purpose of this paper is to review the treatment modalities of acute necrotizing ulcerative gingivitis and illustrate an alternative treatment approach of periodic scaling, root planing, and antimicrobial rinses with 0.12% chlorhexidine. [ncbi.nlm.nih.gov]

Figure 3: 24 h post treatment presenting reduction of erythematous margins and edema. Figure 4: Closer view 24 h after treatment. [jcda.ca]

Prognosis

Failure to treat acute periodontal diseases appropriately can result in progressive loss of periodontal supporting tissues, an adverse change in prognosis, and could result in tooth loss. [oadoi.org]

Prognosis/Outlook for Necrotizing Ulcerative Gingivitis or Trench Mouth As with any existent disease in the world, the sooner you are diagnosed with Necrotizing ulcerative gingivitis or trench mouth, the better your dental health prognosis/ outlook is [epainassist.com]

Prognosis NUG responds very well to treatment and usually can be cured. [sabkadentist.com]

Etiology

The etiology is somewhat unclear, but may involve a complex of FUSOBACTERIUM NUCLEATUM along with spirochetes BORRELIA or TREPONEMA. [ http://www.ebi.ac.uk/ontology/webulous#OPPL_pattern ] Synonyms: ANUG, Angina - Vincents, Vincent angina, acute necrotising [ebi.ac.uk]

Data suggest that the etiology and pathogenesis of necrotizing periodontal diseases may also be distinctive from other periodontal diseases. [ncbi.nlm.nih.gov]

Epidemiology

Current literature on the epidemiology, pathogenesis, immunology, predisposing factors, and treatment of ANUG/NUP is reviewed. [ncbi.nlm.nih.gov]

Albandar, Epidemiology and Risk Factors of Periodontal Diseases, Dental Clinics of North America, 49, 3, (517), (2005). [doi.org]

Pathophysiology

This literature review will provide a better understanding of the epidemiology, etiology, and pathophysiology of ANUG associated with malnutrition. [ncbi.nlm.nih.gov]

Prevention

Orthodontists should be aware of the clinical signs of NUG to ensure early detection and treatment of their patients in order to prevent irreversible loss of the interdental papillae and reduce the likelihood of recurrence. [ncbi.nlm.nih.gov]

Identifying and correcting predisposing factors is important to eradicate the infection and prevent a recurrence. [journals.lww.com]

The most important preventive measure against developing Necrotizing ulcerative gingivitis or Trench Mouth is good oral hygiene. Paying a visit to dentist every six months is also a good way to prevent necrotizing ulcerative gingivitis. [epainassist.com]

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