Acute necrotizing ulcerative gingivitis

Background

1. Severe gingival disease
2. Must distinguish from herpes gingivostomatitis
   1. Herpes has more systemic signs, less bleeding, lack of interdental papilla involvement
3. Associated with immunosuppression, especially HIV

Clinical Features

1. Triad of:
   1. Pain
   2. Ulcerated or "punched out" interdental papillae
   3. Gingival bleeding
2. Secondary signs:
   1. Fetid breath
   2. "Wooden teeth" feeling
   3. Teeth mobility
   4. Fever
   5. Malaise

DDX

Dental Problems

Treatment

1. Chlorhexidine 0.01% oral rinse BID
2. Metronidazole 500mg PO TID
3. Dental debridement and scaling

See Also

• Dental Problems

Source

• ER Atlas
• Tintinalli
• UpToDate