acute necrotizing ulcerative gingivitis

Acute Necrotizing Ulcerative Gingivitis: Causes, Symptoms, and Treatment

For people who are hearing this for the first time, it may feel daunting to understand what acute necrotizing ulcerative gingivitis is. However, this dental condition deserves a close look because of its effect on oral health. This disease is called ANUG, which is not one of those usual dental problems but rather a severe infection accompanied by ulcers, painfulness, and rapid appearance.

This comprehensive review will discuss the features of ANUG, causality, signs, and necessity for immediate medical care. On the other hand, the impacts of ANUG on oral health and beyond.

Join us in exploring the realm of acute necrotizing ulcerative gingivitis, information relevant for navigating through this critical dental issue.

What are acute necrotizing periodontal diseases?

Acute necrotizing periodontal diseases are a group of severe infections affecting the gums and other structures supporting the teeth. Characterized by tissue necrosis (death of tissue), these conditions include acute necrotizing ulcerative gingivitis (ANUG), also known as trench mouth. They are typically marked by rapid onset and can cause symptoms like severe gum pain, bleeding, ulcerated gums, and sometimes a foul taste in the mouth or bad breath.

Often linked to poor oral hygiene, stress, malnutrition, or weakened immune systems, these and other periodontal diseases can lead to significant tissue damage if not promptly and effectively treated. Managing acute necrotizing periodontal diseases usually involves thorough oral hygiene, professional dental cleaning, and sometimes antibiotic therapy, alongside addressing any underlying health issues.

Symptoms of acute necrotizing ulcerative gingivitis

Acute Necrotizing Ulcerative Gingivitis (ANUG), also known as trench mouth, is a severe form of gingivitis characterized by rapid onset and distinctive clinical features. The condition is often associated with predisposing factors such as poor oral hygiene, psychological stress, and immunocompromised states, including HIV infection. Understanding the symptoms of ANUG is essential for timely diagnosis and effective management.

Symptoms of Acute Necrotizing Ulcerative Gingivitis:

  • Rapid Onset: ANUG typically presents with a sudden and acute clinical presentation, marked by a swift onset of symptoms.
  • Gingival Bleeding: Bleeding gums, especially during brushing or eating, are a common symptom of ANUG.
  • Interdental Gingival Necrosis: Necrosis in the interdental gingival areas, often leading to the formation of a necrotic zone, is a distinctive characteristic.
  • Foul-Smelling Breath: Patients with ANUG may experience foul-smelling breath, contributing to the clinical findings of the condition.
  • Papillary Necrosis: Necrosis affecting the papillary regions between the teeth is a notable clinical appearance.
  • Systemic Symptoms: ANUG may exhibit systemic involvement, including systemic signs such as fever, indicating the severity of the disease process.
  • Gum Disease: The disease process involves rapid destruction of the marginal gingiva and periodontal ligament.
  • Distinctive Characteristics: ANUG is characterized by distinctive clinical features, including a neutrophil-rich zone and fusiform bacteria.
  • Risk Factors:¬†Tobacco smoking, poor diet, and immune defects are identified as risk factors contributing to the development of ANUG.

Recognizing these symptoms is imperative for managing patients effectively and instituting timely antibiotic therapy. Moreover, understanding the risk factors and distinctive characteristics aids in both the prevention and management of this severe form of gingivitis. Regular clinical examination and adherence to good oral hygiene practices play pivotal roles in mitigating the impact of ANUG, especially in susceptible populations and developing countries where nutritional deficiencies may exacerbate the condition.

Causes of acute necrotizing ulcerative gingivitis

Acute Necrotizing Ulcerative Gingivitis (ANUG) represents a severe and quickly advancing type of gingivitis, necessitating a thorough comprehension of its causative factors for successful prevention and management. Marked by unique clinical characteristics, ANUG’s development is influenced by local and systemic factors. Our discussion aims to examine the primary causes of Acute Necrotizing Ulcerative Gingivitis in depth.

Causes of Acute Necrotizing Ulcerative Gingivitis:

  • Bacterial Infection: ANUG is primarily caused by bacterial infection, with a notable involvement of anaerobic bacteria, particularly fusospirochetes. These bacteria flourish in poor oral hygiene, leading to the rapid onset of ANUG.
  • Poor Oral Hygiene Practices: Poorly maintained oral hygiene includes failure to brush one’s teeth frequently, use of dental floss, and poor personal dental care, providing favorable conditions for bacteria to thrive, causing plaque build-up and initiation of ANUG.
  • Immunocompromised States: People living with diminished immunity, like HIV-infected and other immunocompromised individuals, have increased chances of contracting ANUG since they normally find it hard to fight bacterial infections.
  • Psychological Stress: Elevated stress levels can contribute to the onset of ANUG. Stress may weaken the immune response, making individuals more susceptible to severe gingival conditions.
  • Preexisting Gingivitis: The presence of preexisting gingivitis, an inflammation of the gums, acts as a precursor to ANUG. Gingivitis provides a foundation for the rapid progression of more severe periodontal diseases.
  • Tobacco Smoking: Tobacco smoking is a significant risk factor for ANUG. When a person smokes, their body cannot fight against bacterial infection, which diminishes oral health.
  • Nutritional Deficiencies: The lack of nutrients, especially Vitamin C deficiency, among the vitamins lacking, contributes to the development of ANUG. Having healthy gums, therefore, depends on a well-balanced diet.
  • Young Adulthood: Young people in this age group, especially those above seventeen years, are much more prone to suffer from the condition known as ANUG. The vulnerability of this age group can be attributed to hormonal changes and lifestyle factors.
  • Fusospirochetal Infection: Fusospirochetal bacteria in the oral cavity are closely associated with ANUG. This bacterium plays a vital role in initiating and advancing this disorder.

Understanding the multifaceted causes of ANUG is essential for implementing targeted preventive measures and tailored treatment approaches. Addressing these factors through improved oral hygiene, stress management, and lifestyle modifications is crucial for preventing the onset and recurrence of Acute Necrotizing Ulcerative Gingivitis.

What is the difference between acute necrotizing gingivitis, ulcerative periodontitis, and necrotizing stomatitis?

periodontal disease hiv infected patients
  • Acute Necrotizing Ulcerative Gingivitis (ANUG): Often referred to as trench mouth, ANUG primarily affects the gum tissue (gingiva). The sudden onset of gum pain, bleeding, ulceration, and a distinctive foul odor characterizes it. ANUG primarily involves the interdental papillae and marginal gingiva but does not extend to the underlying bone or periodontal ligament.
  • Necrotizing Ulcerative Periodontitis (NUP): NUP progresses from ANUG and involves more severe destruction of periodontal tissues. It extends beyond the gums to affect the periodontal ligament and alveolar bone, leading to rapid attachment loss and bone destruction. NUP is more severe than ANUG and can result in tooth loosening or loss if not treated promptly.
  • Necrotizing Stomatitis: This is the most advanced type of acute necrotizing stomatitis. On the other hand, necrotizing stomatitis entails a wider area beyond the gums and periodontal structures. The condition leads to necrosis of large areas of tissue surrounding lips, cheeks, and inside oral and lining mucosa that are found in patients with high immunosuppression levels, for example, advanced HIV/AIDS patients.

Treatment of acute necrotizing ulcerative gingivitis

The treatment of Acute Necrotizing Ulcerative Gingivitis (ANUG) requires a comprehensive and targeted approach due to its rapid onset and distinct clinical presentation. Managing this severe form of gingivitis involves addressing the acute phase of the condition, alleviating symptoms, and preventing its progression to more severe periodontal diseases. This discussion delves into the key strategies employed in treating Acute Necrotizing Ulcerative Gingivitis.

Treatment of Acute Necrotizing Ulcerative Gingivitis:

  • Antibiotic Therapy: Immediate initiation of oral antibiotics is paramount in treating ANUG, aiming to control the bacterial infection responsible for the acute necrotic lesions in the gingival tissues.
  • Oral Hygiene Management: Rigorous oral hygiene practices, including gentle brushing and flossing, are crucial to remove plaque and debris. Regular oral hygiene instructions give patients the tools to maintain optimal oral health.
  • Periodontal Debridement: Professional periodontal debridement, involving removing necrotic tissue and debris, is essential in halting the progression of ANUG and promoting gingival healing.
  • Pain Management: Alleviating pain and discomfort is integral to treating ANUG. Over-the-counter or prescribed pain medications may be recommended.
  • Hydration and Nutritional Support: Adequate fluid intake and nutritional support support the body’s healing processes and overall immune response.
  • Systemic Evaluation: A comprehensive systemic evaluation helps identify any underlying health conditions contributing to ANUG, such as immunocompromised states or systemic diseases, allowing for targeted treatment.
  • Regular Follow-up: Scheduled follow-up appointments are essential for monitoring treatment progress, adjusting therapeutic approaches as needed, and preventing disease recurrence.
  • Patient Education: Educating the patient about the importance of ongoing oral hygiene practices, lifestyle modifications, and regular dental check-ups is crucial for long-term management and prevention of recurrent ANUG episodes.

By employing a combination of antibiotic therapy, oral hygiene management, and supportive measures, the treatment of Acute Necrotizing Ulcerative Gingivitis aims to alleviate acute symptoms, promote healing, and prevent the recurrence of this severe gingival condition. The collaborative efforts of dental professionals and patients are essential for successfully managing and preserving gingival health.

Risk factors for developing acute necrotizing ulcerative gingivitis

Understanding the risk factors associated with the onset of Acute Necrotizing Ulcerative Gingivitis (ANUG) is crucial for effective prevention and early treatment. ANUG is a particularly severe form of gingivitis, notable for its rapid development and distinctive clinical characteristics. This discussion aims to delve into the key risk factors contributing to Acute Necrotizing Ulcerative Gingivitis, offering insights into its underlying causes.

Risk Factors of Developing Acute Necrotizing Ulcerative Gingivitis:

  • Poor Oral Hygiene: Lapses in regular oral hygiene practices, such as inconsistent brushing and flossing, foster conditions ripe for plaque build-up and bacterial growth, thereby elevating the risk of ANUG.
  • Immunocompromised States: Individuals with weakened immune systems, either due to specific health conditions like HIV or through the use of immunosuppressive medications, face a higher likelihood of developing ANUG.
  • Psychological Stress: High levels of stress may play a role in the onset of ANUG, potentially weakening immune defenses and increasing gingival inflammation.
  • Preexisting Gingivitis: Those already experiencing gingivitis are more prone to advancing to more serious gingival issues, including ANUG.
  • Tobacco Smoking: The habit of smoking tobacco is known to significantly increase the risk of various periodontal diseases, including ANUG. This is due to tobacco’s harmful impact on overall gum health and its impairment of the body’s natural infection-fighting capabilities.
  • Poor Nutrition: The absence of essential nutrients in one’s diet, especially vitamins like vitamin C, is closely associated with an increased susceptibility to gum diseases. A balanced and nutrient-rich diet is crucial for maintaining healthy gums.
  • Young Adulthood: There is a noticeable prevalence of ANUG among young adults, particularly those in the late adolescent to early adult years. This pattern is often linked to a mix of lifestyle choices and hormonal changes typical of this age group.
  • Fusospirochetal Infection: Fusospirochetal bacteria in the oral cavity is linked to the development of ANUG. These bacteria play a role in the initiation and progression of the condition.
  • Poor Oral Hygiene Instruction: Lack of proper oral hygiene instruction and awareness contributes to the persistence of risk factors, leading to an increased likelihood of developing ANUG.

Recognizing these risk factors empowers individuals and healthcare professionals to implement targeted preventive measures and early interventions, ultimately reducing the incidence and severity of Acute Necrotizing Ulcerative Gingivitis. Regular dental check-ups and proactive oral care are pivotal in mitigating these risk factors and preserving gingival health.

How to prevent trench mouth

interproximal gingival necrosis

Trench mouth, clinically referred to as acute necrotizing ulcerative gingivitis (ANUG), represents a serious infection of the gums, characterized by symptoms such as pain, bleeding, and forming ulcers in the gum tissue. Originally associated with the unhygienic conditions prevalent in the trenches during World War I, this condition, albeit less frequent in modern times, continues to pose considerable health risks when preventative actions are not implemented.

Good oral hygiene and overall health maintenance are key to preventing trench mouth. This discussion will explore various strategies to prevent trench mouth onset, focusing on oral care practices and general health measures that can mitigate the risk of developing this painful condition.

How to Prevent Trench Mouth:

  • Maintain Good Oral Hygiene: Consistent and thorough brushing and flossing are essential to eliminate plaque and inhibit the accumulation of harmful bacteria in the oral cavity. These routine hygiene measures play a pivotal role in maintaining oral health.
  • Regular Dental Check-Ups: Scheduling and attending regular dental appointments for professional cleanings and examinations are key strategies in the early detection and management of any signs of gum disease. These visits are critical in maintaining oral health and preventing the progression of gum diseases.
  • Healthy Diet: Adhering to a well-balanced diet rich in essential vitamins and nutrients is crucial for overall health. Such a diet bolsters the body’s immune system, a vital factor in combating infections that affect oral health.
  • Manage Stress: High-stress levels can weaken the immune system and make the gums more susceptible to infection. Stress management techniques and a healthy lifestyle can reduce this risk.
  • Avoid Tobacco: Smoking or using tobacco products is a significant risk factor for trench mouth. Quitting tobacco use can greatly reduce the risk of developing this and other oral health issues.
  • Hydration and Saliva Production: Adequate fluid intake and measures to stimulate saliva production, like chewing sugar-free gum, can help maintain oral health.
  • Education on Oral Health: Understanding the importance of oral hygiene and the risks associated with neglecting it is essential for prevention.
  • Immediate Treatment of Existing Oral Issues: Promptly addressing any existing oral health problems, such as cavities or minor gum disease, can prevent them from escalating into more serious conditions like trench mouth.

Preventing trench mouth involves a combination of good oral care practices, healthy lifestyle choices, and regular dental visits. Taking proactive steps and being vigilant about oral health can significantly reduce the risk of developing a trench mouth, ensuring the maintenance of healthy gums and overall oral wellness.


Understanding the causes of acute necrotizing ulcerative gingivitis (ANUG) is vital for effective prevention. Key factors contribute to its onset, including poor oral hygiene, bacterial and viral infections, stress, and immunocompromised states. By prioritizing good oral care, stress management, and addressing immunocompromised conditions, individuals can significantly reduce the risk of ANUG. Regular dental check-ups play a crucial role in early detection and intervention. Taking proactive measures ensures better oral well-being and mitigates the challenges associated with acute necrotizing ulcerative gingivitis.


Acute Necrotizing Ulcerative Gingivitis – ScienceDirect

Acute necrotizing ulcerative gingivitis and its treatment.

Clinical and microbiological studies of acute necrotizing ulcerative gingivitis.

Epidemiological studies of acute necrotizing ulcerative gingivitis.

Acute Necrotizing Ulcerative Gingivitis: A Literature Review

Leave a Reply

Your email address will not be published. Required fields are marked *