Acute ulcerative gingivitis which was previously known as acute necrotizing ulcerative gingivitis, trench mouth, and Vincent’s disease, is an extremely painful infection of the periodontal tissues.
Signs & Symptoms
- It is characterized by punched out inter-dental papilla, ulcers often covered with a grayish membrane and, usually have fetid odor.
- It is rarely associated with systemic signs and symptoms.
- Acute ulcerative gingivitis is most commonly seen in young adult smokers.
- It is rarely seen in children, acute herpetic gingivo-stomatitis is sometimes diagnosed as a acute ulcerative gingivitis.
- Irrigation and debridement of the necrotic area and tooth surfaces.
- Oral hygiene instructions, oral rinses, pain control, and management of systemic manifestations including appropriate antibiotic therapy as necessary.
- The initial management of acute ulcerative gingivitis is usually local debridement that is scaling and root planning under local anesthesia.
- It should be accompanied by improved plaque control with the adjunctive use of chlorhexidine mouthwash, smoking cessation counseling and metronidazole.
When systemic signs and symptoms are present, use the following:
- Metronidazole 400 milligram, 8 to 12 hourly for 5 days
- Chlorhexidine 2% mouth was 10 ml rinsed in mouth for 1 minute, 8 to 12 hourly.
- Chlorhexidine 0.12 percent mouthwash, 15 ml in mouth for 1 minute 8 to 12 hourly.
- Metronidazole is often given as 200 milligrams orally 3 times daily, however, it is recommended as 400 mg 12 hourly. It is considered to increase patient adherence to the treatment.
- Antibiotic therapy alone without debridement and oral hygiene improvement, invariably lead to recurrence in most cases. In an unresponsive case, in patients with HIV infection, specialist referral is indicated.
- Acute ulcerative gingivitis can spread to involve the underlying bone, it should be treated by a specialist.
Article written by Dr. Ajai Singh
Ref: Therapeutic guidelines 2008