Acute necrotizing ulcerative gingivitis

Background

1. Severe gingival disease that may spread to local soft tissue and bone
2. Must distinguish from herpes gingivostomatitis
   1. Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
3. Associated with immunosuppression, especially HIV
   1. Other associations include poor oral hygeine/nutrition/sleep, stress, ETOH/tobacco use, age<21, Caucasians, malaria/measles/parasites

Clinical Features

1. Triad of:
   1. Pain
   2. Ulcerated or "punched out" interdental papillae
   3. Gingival bleeding
2. Secondary signs:
   1. Fetid breath
   2. "Wooden teeth" feeling
   3. Teeth mobility
   4. Fever
   5. Malaise

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Treatment

1. Chlorhexidine 0.01% oral rinse BID
2. Metronidazole 500mg PO TID
3. Dental debridement and scaling

See Also

• Dental Problems

Source

• ER Atlas
• Tintinalli
• UpToDate