Summary about Disease
Necrotizing ulcerative gingivitis (NUG), sometimes referred to as trench mouth or acute necrotizing ulcerative gingivitis (ANUG), is a severe infection of the gums. It causes painful, inflamed, and ulcerated gums with a characteristic foul odor. It is not simply gingivitis; it involves tissue death (necrosis).
Symptoms
Severe gum pain
Bleeding gums, even with gentle touching
Ulcerated or crater-like lesions on the gums, typically between the teeth
Foul breath (fetid odor)
Metallic taste in the mouth
Difficulty swallowing or talking
Fatigue or malaise
Fever (in severe cases)
Swollen lymph nodes (in severe cases)
"Punched-out" appearance of the interdental papillae (the triangular gum tissue between the teeth).
Causes
NUG is generally considered a polymicrobial infection involving several bacteria. Predisposing factors include:
Poor oral hygiene
Stress
Smoking
Malnutrition (particularly vitamin deficiencies)
Immunocompromised state (e.g., HIV/AIDS, chemotherapy)
Pre-existing gingivitis
Lack of sleep
Medicine Used
Antibiotics: Metronidazole, amoxicillin, or other antibiotics may be prescribed to combat the bacterial infection, particularly in severe cases or when systemic symptoms (fever, swollen lymph nodes) are present.
Pain relievers: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. In severe cases, a dentist may prescribe stronger pain medication.
Antiseptic mouthwash: Chlorhexidine mouthwash is often prescribed to help reduce the bacterial load and promote healing.
Hydrogen peroxide rinse: Diluted hydrogen peroxide rinses can help debride the ulcers and reduce bacteria.
Is Communicable
NUG itself is not considered directly communicable in the traditional sense (i.e., it's not spread by direct contact like a cold). However, the underlying bacterial imbalance can potentially be transferred through saliva, but it's the host's susceptibility (poor hygiene, stress, immune compromise) that determines whether NUG develops. Therefore, maintaining good hygiene and avoiding sharing utensils is advisable, particularly if someone has active NUG.
Precautions
Improve oral hygiene: Brush gently with a soft toothbrush after every meal, floss daily, and use an antiseptic mouthwash.
Quit smoking: Smoking significantly increases the risk and severity of NUG.
Reduce stress: Implement stress-reduction techniques like exercise, meditation, or counseling.
Maintain a healthy diet: Ensure adequate nutrition, including vitamins and minerals.
Get enough sleep: Aim for 7-8 hours of quality sleep per night.
Regular dental check-ups: Visit your dentist regularly for professional cleanings and examinations.
Avoid sharing utensils particularly when someone has active NUG.
How long does an outbreak last?
With prompt treatment, an outbreak of NUG can resolve within 1-2 weeks. Without treatment, it can become chronic and cause significant tissue damage and bone loss.
How is it diagnosed?
Diagnosis is typically made by a dentist or periodontist based on:
Clinical examination: Visual inspection of the gums reveals characteristic ulcers, inflammation, and necrosis.
Patient history: Assessing symptoms, risk factors (smoking, stress, etc.), and medical history.
Exclusion of other conditions: Ruling out other potential causes of gum disease, such as herpes simplex virus infection.
Sometimes a culture may be taken to determine the specific bacteria involved, but this is not always necessary for diagnosis.
Timeline of Symptoms
The onset can be rapid, often developing within a few days. A typical timeline might look like this:
Day 1-2: Initial gum pain, tenderness, and slight bleeding.
Day 3-5: Ulcerations develop, often in the interdental papillae, accompanied by increased pain, foul odor, and bleeding.
Day 5-7: Symptoms worsen, potentially including fever, swollen lymph nodes, and difficulty swallowing.
Following treatment (if initiated promptly): Improvement in symptoms within a few days, with complete resolution within 1-2 weeks.
Important Considerations
NUG can be a sign of underlying health problems, such as HIV/AIDS or other immune deficiencies. A dentist may recommend further medical evaluation.
Failure to treat NUG can lead to permanent damage to the gums and bone, resulting in tooth loss.
Proper diagnosis and treatment are crucial to prevent complications and ensure a full recovery.
Maintaining good oral hygiene is essential for preventing recurrence.
Follow-up appointments with a dentist are important to monitor healing and prevent future episodes.