Acute necrotizing ulcerative gingivitis

This article is about the physiologic disorder. For the similarly named band, see Trenchmouth.

Necrotizing ulcerative gingivitis/periodontitis
Classification and external resources
ICD-10	A69.1
ICD-9	101
DiseasesDB	13866
MeSH	D005892

Acute necrotizing ulcerative gingivitis (ANUG) or necrotizing ulcerative gingivitis (NUG) is a sub-classification of necrotizing periodontal disease, an infection of the gum tissue.^[1] This presents as an acute infection of the gingiva without involvement of the other tissues of the periodontium. If the infection has progressed deeper into the periodontal tissues, it is subclassified as "necrotizing ulcerative periodontitis" (NUP).^[2][3]

The condition is also commonly referred to as "trench mouth" and "Vincent's angina", named after French physician Henri Vincent (1862–1950). Other synonyms include "acute membranous gingivitis", "fusospirillary gingivitis", " fusospirillosis", "fusospirochetal gingivitis", "necrotizing gingivitis", "phagedenic gingivitis", "ulcerative gingivitis", "Vincent stomatitis", "Vincent gingivitis", and "Vincent infection".^[4]

Etiology

Necrotizing periodontal disease is caused by a bacterial infection that includes anaerobes such as P. intermedia^[3] and Fusobacterium as well as spirochetes, such as Borrelia and Treponema.

In the late 1980s-early 1990s, it was originally thought that necrotizing periodontal diseases were strictly a sequela of HIV, and it was even called HIV-associated periodontitis.^[5] It is now understood that its association with HIV/AIDS was due to the immunocompromised status of such patients, and it occurs with higher prevalence in association with other diseases in which the immune system is compromised.^[2]

Signs and symptoms

Clinical features of necrotizing periodontal disease may include:^[2]

• necrosis and/or punched outulceration of the interdental papillae ("punched-out papillae")^[3] or gingival margin
• pseudomembranous formation
• painful, bright red marginal gingiva that bleed upon gentle manipulation
• halitosis

Coincident factors may include heavy smoking and poor nutrition,^[2] especially for those presenting with necrotizing ulcerative periodontitis.^[3]

Treatment

Treatment includes irrigation and debridement of necrotic areas (areas of dead and/or dying gum tissue), oral hygiene instruction and the uses of mouth rinses and pain medication. As these diseases are often associated with systemic medical issues, proper management of the systemic disorders is appropriate.^[2]

Prognosis

Untreated, the infection may lead to rapid destruction of the periodontium and can spread, as necrotizing stomatitis or noma, into neighbouring tissues in the cheeks, lips or the bones of the jaw. As stated, the condition can occur and be especially dangerous in people with weakened immune systems. This progression to noma is possible in malnourished susceptible individuals, with severe disfigurement possible.

Notable people affected

• author William Styron^[6]
• football player Ernie Davis^[7]
• actress Marilyn Monroe ^[8]
• artist Robert Mapplethorpe^[9]
• paratrooper and author Donald Burgett

See also

• Angina bullosa haemorrhagica
• Trench foot
• Riggs' disease
• List of cutaneous conditions

References

1. ^ "Definition of Acute necrotizing ulcerative gingivitis (ANUG)". Medterms.com. 1999-02-18. http://www.medterms.com/script/main/art.asp?articlekey=6577. Retrieved 2010-02-13. 
2. ^ ^{a b c d e} American Academy of Periodontology (May 2000). "Parameter on acute periodontal diseases. American Academy of Periodontology" (PDF). J. Periodontol. 71 (5 Suppl): 863–6. doi:10.1902/jop.2000.71.5-S.863. PMID 10875694. http://perio.org/resources-products/pdf/863.pdf. 
3. ^ ^{a b c d} American Academy of Periodontology (1999). "Consensus report: Necrotizing Periodontal Diseases". Ann. Periodontol. 4 (1): 78. doi:10.1902/annals.1999.4.1.78. http://www.joponline.org/doi/pdf/10.1902/annals.1999.4.1.78. 
4. ^ "Definition of Vincent angina". Medterms.com. 2001-09-13. http://www.medterms.com/script/main/art.asp?articlekey=6261. Retrieved 2010-02-13. 
5. ^ NYS Department of Health AIDS Institute. "Clinical Manifestations and Management of HIV-Related Periodontal Disease". Oral Health Care for People with HIV Infection: HIV Clinical Guidlines. p. 31. 
6. ^ Styron, William (September 18, 1995). "Personal History, 'A CASE OF THE GREAT POX'". The New Yorker: p. 62. https://www.newyorker.com/archive/1995/09/18/1995_09_18_062_TNY_CARDS_000372118. 
7. ^ "Movie about Ernie Davis looks back at the Syracuse star, a Cleveland Brown who never was". The Plain Dealer. September 05, 2008. http://www.cleveland.com/sports/index.ssf/2008/09/movie_about_ernie_davis_looks.html. 
8. ^ Burbank, Jeff (1 October 2006). Las Vegas Babylon: true tales of glitter, glamour, and greed. Franz Steiner Verlag. p. 83. ISBN 9781861059666. http://books.google.com/books?id=P3BklV6IFssC. 
9. ^ Smith, Patti (2010). Just Kids. New York: HarperCollins. p. 85.