1,602 Words
ACUTE NECROTIZING ULCERATIVE GINGIVITIS
(Fusospirochetosis; Trench Mouth; Vincent's Infection or Angina)
Acute Necrotising Ulcerative Gingivitis (ANUG) is an acute or recurrent gingivitis of young and middle-aged adults characterised clinically by gingival erythema and pain, fetid odour, necrosis and sloughing of interdental papillae and marginal gingiva which gives rise to a grey pseudomembrane; fever, regional lymphadenopathy, and other systemic manifestations may also be present. According to Keys and Bartold (2000) ANUG primarily affects young adults of 18 to 30 years and is now relatively uncommon. This disease has been described as far back as the days of Hippocrates and is known by many synonyms. Shiloah (2008) describes ANUG as having a complex aetiology. Various micro-organisms are often present in the areas of the gingival tissues in large numbers and are felt to play a significant but poorly defined role in the pathogenesis. Furthermore, numerous studies have hypothesized on the significance of secondary predisposing aetiological factors, including poor oral hygiene, stress, smoking, alcohol consumption, impaired chemotaxis, general debilitation and malnutrition. Folayan (2004) argues that with the advent of antibiotics and with improved nutritional status, the incidence had been virtually eliminated in developed countries. However, with the increasing incidence of severe immunodeficiency conditions such as Acquired Immunodeficiency Syndrome (AIDS) the lesion has once more, become a well recognized and often encountered clinical entity in developed countries. In developing countries, the condition remains a commonly diagnosed clinical lesion because of the persistently poor nutritional status. ANUG will not kill an individual and is not contagious, however, the condition if allowed to progress can, particularly in less developed countries, lead to teeth loss and become so painful that the individual may become extremely malnourished which may cause subsequent organ failure and death. Additionally, Church and Elsayed (2002) argue that ‘dental infections are the most common infectious diseases affecting humans worldwide.
The signs and symptoms of acute necrotizing ulcerative gingivitis can include:
a. Severe gum pain.
b. Bleeding from gums when pressed even delicately.
c. Red or swollen gums.
d. Pain when eating or swallowing.
e. A gray film on your gums.
f. Crater-like sores (ulcers) on the gums between the patient’s teeth (interdental papillae).
g. A complaint of a foul taste in the patient’s mouth.
h. Bad breath.
i. Fever.
j. Swollen lymph nodes around the patient’s head, neck or jaw.
ANUG symptoms can develop quickly. Initially there may be symptoms of a gum problem other than ANUG, such as gingivitis or periodontitis. But all forms of gum disease can be serious and most tend to get worse without treatment. A dental examination should identify the probable diagnosis of ANUG, with a swab taken from the affected area to confirm the presence of ANUG causing bacteria. It is standard practice to immediately prescribe a broad-based antibiotic before the results of the swab are received, to do otherwise may allow the disease to progress considerably. This can be administered orally in tablet form, although direct application to the infected areas in the form the gel is also common practice. Malnourished individuals are immuno-compromised and this can affect the person’s susceptibility to infection, which would exacerbate the gingival response to the presence of bacterial plaque. The most widely studied nutritional deficit has been lack of vitamin C, or scurvy, in which the gum is bright red, swollen, ulcerated and presents a tendency to bleed.
