NECROTIZING ULCERATIVE GINGIVITIS

Question 1

Definition of Necrotizing Ulcerative Gingivitis (NUG)

Answer 1

common, severe, non-contagious bacterial infection of the gums with sudden onset.

Question 2

NUG is also known as

Answer 2

“trench mouth” and “Vincent’s Angina.”

Question 3

Etiology of NUG

Answer 3

Acute painful bacterial infection of the gums brought on by opportunistic Fusobacteria and spirochetes as a result of immunosuppression, extreme stress, poor oral hygiene, malnutrition, and/or smoking.

Question 4

Diagnosis for NUG

Answer 4

(1) Ulcerations present on dental papillae and marginal gingiva. These have a
characteristically punched-out appearance and are covered by a grey pseudo membrane.
(2) Overwhelming foul breath.
(3) Rapid onset may be accompanied by malaise or fever.
(4) Acutely painful, bleeding gingiva.
(5) Excessive salivation.
(6) Odynophagia.
(7) Regional lymphadenopathy.

Question 5

treatment of NUG

Answer 5

(1) Patient uses soft toothbrush to wipe teeth.
(2) Oral hygiene and nutrition instruction.
(3) Hourly rinses with warm saline or twice daily rinses with hydrogen peroxide or
chlorhexidine.
(4) Remove factors contributing to disease.
(5) After improvement in 24-48 hours, debride gently with a hand scaler or ultrasonic device.
(6) If no improvement after 48 hours:
(a) Penicillin VK 500mg qid or
(b) Erythromycin 250mg qid or
(c) Tetracycline 250mg qid
(7) MAGIC MOUTHWASH, 1:1:1 ratio of
(a) 2% viscous lidocaine
(b) Liquid diphenhydramine
(c) Kaopectate or Maalox
(8) Treat symptoms
(a) Systemic analgesia
(b) Hydration
(c) Antipyretics
(d) Soft bland diet
(e) Rest

Question 6

Complications of NUG

Answer 6

(1) Necrotizing periodontitis and tooth loss.

(2) Necrotizing stomatitis.

Question 7

Differential Diagnosis of NUG

Answer 7

(1) Herpetic Gingivostomatitis.

Question 8

Disposition of NUG

Answer 8

(1) Retain. Refer to dental if does not resolve.