Acute Necrotizing Ulcerative Gingivitis (Anug)/ Vincent's Stomatitis/ Trench Mouth

Acute Necrotizing Ulcerative Gingivitis (Anug)/ Vincent's Stomatitis/ Trench Mou

Periodontal diseases are often classified according to their severity.Gingivitis is an infection that occurs when bacteria invade soft tissues, bone, and other places. They range from mild gingivitis, to more severe periodontitis, and finally acute necrotizing ulcerative gingivitis, which can be life threatening.Infection begins when the body's immune system is overwhelmed. It is the interaction between host and bacteria, mostly fusospirochetes.In necrotizing condition, punchedout gingival margin, pseudomembrane that peels off, leaving row areas. Mariginal gingiva affects, other oral tissue rarely.


Acute necrotizing ulcerative gingivitis is a rapidly progressive ulceration typically starting at the tips of the interdental papilla, spreading along the gingival margins and going on to acute destruction of the periodontal tissue.

ANUG is characterized by:

  1. Sudden onset
  2. Precede and episode of debilitating disease like respiratory tract infection.

As a result, they often developed trench mouth, a severe form of gingivitis that causes painful, infected, bleeding gums and ulcerations.Trench mouth is also known as Vincent's stomatitis and acute necrotizing ulcerative gingivitis (ANUG). Fortunately, regular brushing and flossing, professional tooth cleaning and antibiotics can usually clear up the infection from trench mouth. And practicing good oral hygiene can help prevent future problems.

Oral symptoms:

Oral signs:

Extra oral signs/symptoms:

(i) Mild to moderate case:

(ii) Severs form:

(iii) Very severe from:

It's a mistake to think that a disease of the mouth isn't serious enough to cause harm to the rest of your health. Acute necrotizing ulcerative gingivitis can become so bad that it is difficult for the patient to eat or swallow.Relatively uncommon in children. It's pretty obvious as to why that's a bad idea. Prompt treatment is essential to correct the problem and allow the sufferer relief from this mouth disease.

Histopathology:

  1. Inflammation of marginal gingiva involving both stratified squamus epithelium and underlying connective tissue.
  2. Surface epithelium is destroyed and replace by a pseudomembranous meshwork of fibrin, necrotic cells, polymorphonuclear cells and various type of microorganism.
  3. The underlying connective tissue is hyperemic with infiltration of PMN's. Numerus plasma cells may appear the periphery of the infiltration.
  4. At the immediate border, the epithelium is edematous and individual cells exhibit degeneration.

Causes:

A. Microorganisms:

i) Fusiform bacilli mainly, e. g. Fusobacterium specis (F. nucleatum)

ii) Spirochetes.

iii) Filamentus organism, e. g. Borrelia vencenti.

B) Predesposing factors:

a) Local factors:

i) Pre existing gingivitis.

ii) Chemical irritants e. g. smoking

b)Systemic factors:

i) Nutritional deficiencydue to

ii) Debilitating disease:

c)Psychosomatic:

Acute Necrotizing Ulcerative Gingivitis appears with stress. College students can get it during finals and people breaking up can get it. The onset of some medical conditions such as HIV infection can cause it. Regardless of the cause, it should be treated and the cause found. People who smoke, have poor nutrition and who have dental infections are susceptible.

Clinical course of disease:

(i) May subside spontaneously if history of recurrence

(ii) If untreated may cause

Treatment:

Three major aspects of treatment are:

i) Physical (oral hygine) measures:

2. Drugs:

Metronidazole (for mixed infection) 200 mg, 3times daily for 3 days, after meal.

3. Use of oxidising agents:

Rinsing with-

Advantage of Metronidzole:

i) Rapidly acting

ii) Not sensitinzing like penicillin,

iii. Not prone to promote superinfection.

Comments

excellent and thorough review

excellent and thorough review for professionals, thank you

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