Ver el código de «Acute necrotizing ulcerative gingivitis»

==Background==
[[File:Periodontium.png|thumb|Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.]]
*Also known as "trench mouth"
*Often abbreviated as ''ANUG''
*Severe gingival disease that may spread to local soft tissue and bone
*Must distinguish from [[Herpes gingivostomatitis]]
**Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
*Bacteria involved: anaerobic fusobacterium and ''Borellia spirochete''<ref>J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.</ref>, Treponema, Selenomonas, Prevotella
*[[Vincent's angina]] is sometimes confused with [[ANUG]], but the former is tonsillitis and pharyngitis, and the latter involves the gums. There is not currently a consensus on whether ANUG and [[Vincent's angina]] are separate entities or simply different presentations of the same entity

===Associated Conditions<ref>J Periodontol. 1986 Mar;57(3):141-50. Acute necrotizing ulcerative gingivitis. A review of diagnosis, etiology and treatment. Johnson BD, Engel D.</ref>===
*Immunosuppression, especially [[HIV]]
*Poor oral hygiene/nutrition/sleep
*Stress
*[[ETOH]]/tobacco use
*Age<21
*Caucasians
*[[malaria]]/[[measles]]/[[parasites]]

==Clinical Features==
[[File:Ulcerative necrotizing gingivitis.jpg|thumb|Mild presentation at the typical site on the gums of the lower front teeth.]]
===Early===
*[[Fever]]
*Halitosis
*[[dental problems|Dental/mouth pain]]
*Gingival bleeding
*Teeth mobility
*Malaise

===Secondary signs===
*Fetid breath with metallic taste
*"Wooden teeth" feeling
*Regional [[lymphadenopathy]]
*Ulcerated, with grayish pseudomembrane or "punched out" interdental papillae
*Blunting of the typically pointed edges of the papillae

==Differential Diagnosis==
{{Dental Problems DDX}}

==Evaluation==
*Usually clinical

==Management==
{{ANUG Treatment}}

For pain management, can consider inferior alveolar block or viscous lidocaine diluted and spread across the gums.
===Consultation===
ENT or OMFS consult for dental debridement may be required in severe infections

==Disposition==
Discharge

==See Also==
*[[Dental problems]]

==References==
<references/>

[[Category:ENT]]
[[Category:ID]]