Acute Ulcerative Gingivitis

Introduction

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.

 

 

Treatment

  • 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.

 

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Management

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.

Or

  • 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.

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Article written by Dr. Ajai Singh

Ref: Therapeutic guidelines 2008