Acute Necrotising Ulcerative Gingivitis (ANUG)

Last updated: 14th August 2024

Written by Dr Zaeem Jafri

Causes | Symptoms | Diagnosis | Treatment | Speak to a dentist

What is ANUG?

Acute Necrotizing Ulcerative Gingivitis, commonly known as ANUG or "trench mouth," is a severe and rapidly progressing form of gum disease. It is characterised by the painful inflammation of the gums, leading to ulceration and tissue death (necrosis).

Unlike more common forms of gingivitis, ANUG requires immediate attention due to its aggressive nature.

A patient with ANUG showing inflamed gums

Causes of ANUG

ANUG is primarily caused by a bacterial infection, often involving the overgrowth of bacteria such as Fusobacterium and Prevotella intermedia. These bacteria thrive in an environment where oral hygiene is poor, and when the body’s immune system is weakened. Several factors can increase the risk of developing ANUG, including:

  • Poor Oral Hygiene: Inadequate brushing and flossing lead to the accumulation of plaque, creating a breeding ground for harmful bacteria.

  • Stress: High levels of stress can weaken the immune system, making it easier for infections to take hold.

  • Smoking: Tobacco use, especially smoking, significantly increases the risk of ANUG by damaging gum tissue and reducing blood flow to the gums.

  • Poor Nutrition: A diet lacking in essential nutrients can impair the body's ability to fight off infections.

  • Immunosuppression: Individuals with weakened immune systems, due to conditions like HIV/AIDS or chemotherapy, are more susceptible to ANUG.

Symptoms of ANUG

ANUG can cause a range of distressing symptoms, which often develop suddenly. These include:

  • Severe Gum Pain: Intense pain in the gums, which may make eating and drinking difficult.

  • Ulcers: The formation of painful ulcers on the gums, often covered with a grayish-white membrane.

  • Bleeding Gums: Gums that bleed easily, even with light contact.

  • Foul Breath: A distinctive, foul odor from the mouth, often referred to as "trench mouth."

  • Metallic Taste: A persistent metallic taste in the mouth.

  • Swollen Lymph Nodes: Tender and swollen lymph nodes, particularly around the neck and jaw.

  • Fever and Malaise: General feelings of unwellness, including fever and fatigue, may accompany the condition in more severe cases.

Diagnosing ANUG

Diagnosing Acute Necrotizing Ulcerative Gingivitis (ANUG) typically involves a clinical examination by a dentist or healthcare professional. The diagnosis is primarily based on the distinctive symptoms and visual signs of the condition.

Steps in Diagnosing ANUG

  1. Medical History: The dentist will ask about your medical history, including any recent illnesses, stress levels, smoking habits, oral hygiene practices, and overall health. This helps identify risk factors that might have contributed to the development of ANUG.

  2. Clinical Examination: The dentist will examine your gums and mouth for the characteristic signs of ANUG, which include:

    • Painful, inflamed gums that may be red and swollen.

    • Ulcers on the gums, often covered by a greyish-white layer of dead tissue.

    • Bleeding of the gums, even with gentle probing.

    • Foul breath (halitosis) with a distinctive odor.

    • Crater-like sores or lesions between the teeth.

  3. Assessment of Symptoms: In addition to the visible signs, the dentist will also evaluate the symptoms you describe, such as severe gum pain, bad breath, metallic taste, and any systemic symptoms like fever or swollen lymph nodes.

  4. Plaque and Tartar Evaluation: The dentist may assess the level of plaque and tartar buildup on your teeth, as these are key factors that can contribute to the development of ANUG.

  5. Radiographs (X-rays): In some cases, X-rays may be taken to check for underlying bone loss or other dental issues that could be associated with the condition.

Differential Diagnosis

The dentist may need to rule out other conditions that could present with similar symptoms, such as:

  • Chronic gingivitis

  • Herpetic gingivostomatitis

  • Periodontitis

  • Oral thrush

Treatment of ANUG

Prompt treatment of ANUG is essential to prevent further complications and the spread of infection. Treatment typically involves:

  • Professional Cleaning: A dentist or dental hygienist will perform a thorough cleaning to remove plaque and dead tissue.

  • Antibiotics: Prescribed to control the bacterial infection, commonly including metronidazole or penicillin.

  • Pain Relief: Over-the-counter pain relievers like ibuprofen can help manage discomfort.

  • Improved Oral Hygiene: Regular brushing, flossing, and the use of antiseptic mouthwash are crucial to prevent recurrence.

  • Lifestyle Changes: Quitting smoking, reducing stress, and maintaining a balanced diet can significantly reduce the risk of future episodes.

Preventing ANUG

Preventing ANUG is largely about maintaining good oral hygiene and overall health. Here are some key preventive measures:

  • Regular Dental Checkups: Routine visits to the dentist help catch early signs of gum disease before they progress to ANUG.

  • Effective Oral Hygiene: Brushing at least twice a day, flossing daily, and using mouthwash can keep harmful bacteria at bay.

  • Healthy Lifestyle: A balanced diet rich in vitamins and minerals, regular exercise, stress management, and avoiding tobacco use are all important for overall gum health.

When to See a Dentist

If you experience any symptoms of ANUG, it’s important to see a dentist immediately. Early treatment can prevent the condition from worsening and causing more serious complications, such as tooth loss or the spread of infection to other parts of the body.

Conclusion

Acute Necrotizing Ulcerative Gingivitis is a serious condition that requires prompt attention. By understanding the causes, recognising the symptoms, and knowing how to manage and prevent it, you can protect your oral health and avoid the severe consequences associated with this aggressive form of gum disease. Always consult with a dental professional if you suspect you might have ANUG or if you have any concerns about your gum health.

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