Acute Necrotizing Ulcerative Gingivitis (ANUG)

  1. Rapid onset diffuse mouth pain, halitosis, incr pain with chewing
  2. Spont. bleeding gums, ulceration/ sloughing of gingiva
  3. Malaise, low grade fever
  4. Predisposing: poor oral hygiene, local trauma, emotional and physical stress, smoking, immunodeficiencies; often in young pts
  5. R/O systemic diseases when lesions extend beyond gingival tissue to surrounding areas
  6. P/E:
  7. Labs: not helpful; gram stain normal flora


  1. Bacteria from pre-existing periodontal disease invade non-necrotic tissue, causing inflamed gingiva w/ulcerated & necrotic lesions


  1. Topical medications
  2. Pain control
  3. Debride pseudomembrane: use gauze or cotton-tip applicator
  4. Dilute hydrogen peroxide rinses (3%)
  5. Antibiotics


  1. Admit pts w/extensive dz & systemic signs, immunocompromised pts requiring IV abx, severely dehydrated pts
  2. Outpt therapy
  3. F/U w/dentist