II. Pathophysiology

  1. Acute fusospirochetal infection of the Gingiva

III. Risk Factors

  1. Emotional stress
  2. HIV Infection
  3. Tobacco abuse
  4. Poor Oral Hygiene
  5. Nutritional deficiency

IV. Findings: Signs and symptoms

  1. Systemic symptoms
    1. Fever
    2. Malaise
    3. Lymphadenopathy
  2. Mnemonic: "3 B's"
    1. Bad breath (Fetor Oris from tissue necrosis)
    2. Bad taste
    3. Gingival Bleeding
  3. Painful Gingivitis
    1. Redness
    2. Swelling
    3. Oral Ulcers
  4. Specific oral findings
    1. Punched out lesions on interdental papillae
    2. Mucus membranes covered with grayish necrotic pseudomembrane
      1. Surface bleeds when removed

V. Differential Diagnosis

VI. Management

  1. Good Oral Hygiene
  2. Refer to Dentistry for debridement
  3. Antibiotics (if systemic symptoms)
    1. Metronidazole (Flagyl) 250-500 mg orally three times daily for 7 days AND
    2. Amoxicillin 1000 mg twice daily for 7 days

VII. References

  1. Broderick and Deak (2015) Crit Dec Emerg Med 29(1): 2-8
  2. Atout (2013) J Can Dent Assoc 79:d46 [PubMed]

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Ontology: Necrotizing Ulcerative Gingivitis (C0017575)

Definition (NCI) A bacterial infectious process affecting the gums. It is characterized by the development of necrotic, ulcerated, and painful lesions with creation of pseudomembranes extending along the gingival margins.
Definition (MSH) An acute or chronic GINGIVITIS characterized by redness and swelling, NECROSIS extending from the interdental papillae along the gingival margins, PAIN; HEMORRHAGE, necrotic odor, and often a pseudomembrane. The condition may extend to the ORAL MUCOSA; TONGUE; PALATE; or PHARYNX. The etiology is somewhat unclear, but may involve a complex of FUSOBACTERIUM NUCLEATUM along with spirochetes BORRELIA or TREPONEMA.
Concepts Disease or Syndrome (T047)
MSH D005892
ICD10 A69.1
SnomedCT 240675006, 171847006, 30896000, 266145002, 186961005, 278519005, 186962003, 186960006, 154391003, 266213004, 399050001, 172697005, 173599005
English Gingivitis, Necrotizing Ulcerative, Mouth, Trench, Trench Mouth, Ulcerative Gingivitis, Necrotizing, Vincents Infection, Infection, Vincent's, ANUG - Acute necro ulcer ging, AUG - Acute ulcer gingivitis, Acute necrotis ulcertve gingiv, Acute necrt ulcer gingivostom, VINCENTS INFECT, acute necrotizing ulcerative gingivitis, Vincent's gingivitis (diagnosis), acute necrotizing ulcerative gingivitis (diagnosis), Vincent Angina, Vincent infection, Necrotizing ulcerative (acute) gingivostomatitis, Necrotizing ulcerative (acute) gingivitis, Gingivitis, Necrotizing Ulcerative [Disease/Finding], ulcerative gingivostomatitis, vincent's stomatitis, stomatitis vincent's, anug, trench mouth, vincent's gingivitis, vincent's infection, angina vincent, vincent angina, vincent's angina, vincents angina, acute necrotizing gingivitis, gingivitis necrotizing ulcerative, mouth trench, necrotizing gingivitis, Acute Membranous Gingivitides, Phagedenic Gingivitides, Vincent Gingivitis, Acute Necrotizing Ulcerative Gingivitis, Fusospirilloses, Gingivitides, Acute Membranous, Membranous Gingivitides, Acute, Fusospirillary Gingivitis, Phagedenic Gingivitis, Gingivitis, Phagedenic, Vincents Stomatitis, Fusospirillosis, Stomatitis, Vincent's, Vincent Stomatitis, Acute Membranous Gingivitis, Gingivitis, Acute Membranous, Membranous Gingivitis, Acute, Fusospirillary Gingivitides, Gingivitis, Vincent's, Vincent's Stomatitis, Gingivitides, Fusospirillary, Gingivitides, Phagedenic, Gingivitis, Fusospirillary, Vincent's Gingivitis, Vincents Gingivitis, vincent's infection (diagnosis), Fusospirochetosis, Acute necrotising ulcerative gingivitis (disorder), Acute necrotising ulcerative gingivostomatitis (disorder), (Vincent's angina) or (trench mouth), (Vincent's angina) or (trench mouth) (disorder), Necrotising gingivitis, Necrotizing gingivitis, Gingivitis, Necrotizing ulcerative, Vincent Infection, Vincent's Infection, Infection, Vincent, Trench mouth, Vincent's infection, ANUG, Acute necrotizing ulcerative gingivitis, Acute necrotizing ulcerative stomatitis, Spirochaetal stomatitis, Vincent's gingivitis, Vincent's stomatitis, ANUG - Acute necrotising ulcerative gingivitis, ANUG - Acute necrotizing ulcerative gingivitis, AUG - Acute ulcerative gingivitis, Acute necrotising ulcerative gingivitis, Acute necrotising ulcerative gingivostomatitis, Acute necrotizing ulcerative gingivostomatitis, Acute ulcerative gingivitis, Spirochetal stomatitis, Acute necrotising ulcerative stomatitis, Acute necrotizing ulcerative gingivitis (disorder), Acute necrotizing ulcerative gingivostomatitis (disorder), Acute ulcerative gingivitis (disorder), Acute ulceromembranous gingivitis, Vincent's infection (disorder), fusospirillosis, gingivitis; acute, necrotizing, gingivitis; necrotizing ulcerative, gingivitis; vincent's, infection; vincent's, acute; gingivitis, necrotizing, necrotizing ulcerative; gingivitis, spirochetal; stomatitis, stomatitis; spirochetal, vincent's; infection, vincent's; stomatitis, Acute necrotising ulcerative gingivitis [Ambiguous], Acute necrotising ulcerative gingivostomatitis [Ambiguous], Acute necrotizing ulcerative gingivitis (disorder) [Ambiguous], Early acute necrotising gingivitis, Early acute necrotizing gingivitis, Vincent's disease, Necrotizing Ulcerative Gingivitis, Vincent's infection, any site
Dutch necrotiserende gingivitis, loopgraafmond, Plaut-Vincent; infectie, Plaut-Vincent; stomatitis, acuut; gingivitis, necrotiserend, gingivitis; Plaut-Vincent, gingivitis; acuut, necrotiserend, gingivitis; necrotiserend ulceratief, infectie; Plaut-Vincent, necrotiserend ulceratief; gingivitis, spirocheten; stomatitis, stomatitis; spirocheten, Gingivitis, necrotiserende ulceratieve, Necrotiserende ulceratieve gingivitis, Ulceratieve gingivitis, necrotiserende, Vincent-infectie, Loopgraafmond
French Angine de Vincent, Gingivite nécrosante, Gingivite ulcéreuse, Gingivite de Vincent, Gingivite ulcéreuse nécrosante, Maladie de Vincent, Gingivite ulcéro-nécrotique, Gingivite ulcéronécrotique
German nekrotisierende Gingivitis, Mundfaeule, Plaut-Vincent-Infektion, Gingivitis, nekrotisierende ulzeröse, Plaut-Vincent-Gingivitis
Italian Gengivite necrotizzante, Gengivite ulcerosa, Infezione di Vincent, Bocca da trincea, Gengivite ulcerosa necrotizzante
Portuguese Gengivite necrosante, Angina de Vincent, Boca de Trincheira, Gengivite Ulcerativa Necrosante, Infecção de Vincent
Spanish Gingivitis necrotizante, Boca con surcos, boca de trinchera, fusoespiroquetosis, estomatitis ulcerativa necrosante aguda, estomatitis ulcerativa necrotizante aguda, estomatitis espiroquetal, gingivitis ulcerativa aguda, gingivitis ulcerativa necrotizante aguda, gingivitis ulcerativa necrotizante aguda (trastorno), estomatitis de Vincent (trastorno), estomatitis de Vincent, gingivitis de Vincent, gingivitis ulcerativa aguda necrotizante (trastorno), gingivitis ulcerativa aguda necrotizante, gingivitis ulcerativa necrosante aguda (trastorno), gingivitis ulcerativa necrosante aguda, gingivitis ulcerosa aguda necrosante (trastorno), gingivitis ulcerosa aguda necrosante, gingivitis ulcerosa aguda, gingivoestomatitis ulcerosa aguda necrosante (trastorno), gingivoestomatitis ulcerosa aguda necrosante, infección de Vincent (trastorno), infección de Vincent, Boca de Trinchera, Gingivitis Ulcerosa Necrotizante, Infección de Vincent
Japanese 壊死性歯肉炎, ザンゴウコウナイエン, エシセイシニクエン, 潰瘍性偽膜性アンギナ, 急性壊死性潰瘍性歯肉炎, ワンサンアンギナ, ワンサンのアンギナ, ヴィンセン口内炎, 壊死性潰瘍性歯肉炎, 潰瘍性口内炎, Vincent感染症, 口内炎-塹壕, プラウ・ワンサン口内炎, プローアンギナ, プローのアンギナ, ヴァンサン感染症, 壊死性潰瘍性歯ぎん炎, 口内炎-スピロヘータ, ざんごう口内炎, ヴァンサン口内炎, 紡錘菌口内炎, 口内炎-Plaut-Vincent, スピロヘータ口内炎, プロー-ヴァンサン口内炎, ワンサン口内炎, 壊死性潰瘍性口内炎, 塹壕口内炎, ヴィンセン感染症, 口内炎-潰瘍性, え死性潰瘍性歯肉炎, 口内炎-プロー-ヴァンサン, 口内炎-紡錘菌, ワンサン感染症, 歯肉炎-壊死性潰瘍性, Plaut-Vincent口内炎
Swedish Gingivit, nekrotiserande ulcerös
Czech gingivitida nekrotizující ulcerózní, Zákopová ústa, Nekrotizující gingivitida, Nekrotizující zánět dásně, Vincentova infekce, Vincentova stomatitida, fusospirilóza
Finnish Kuolioituva haavainen ientulehdus
Russian VENSANA-SIMANOVSKOGO ANGINA, SIMANOVSKOGO-PLAUTA-VENSANA ANGINA, STOMATIT IAZVENNYI, VENSANA INFEKTSIIA, ANGINA VENSANA, GINGIVIT IAZVENNO-NEKROTICHESKII, АНГИНА ВЕНСАНА, ВЕНСАНА ИНФЕКЦИЯ, ВЕНСАНА-СИМАНОВСКОГО АНГИНА, ГИНГИВИТ ЯЗВЕННО-НЕКРОТИЧЕСКИЙ, СИМАНОВСКОГО-ПЛАУТА-ВЕНСАНА АНГИНА, СТОМАТИТ ЯЗВЕННЫЙ
Croatian GINGIVITIS, NEKROTIČNI ULCEROZNI
Polish Zapalenie dziąseł wrzodziejące, Angina Plaut-Vincenta, Zapalenie jamy ustnej wrzodziejąco-martwicze
Hungarian Gingivitis necrotisans, Necrotizáló gingivitis, Necrotisalo fekélyes gingivitis
Norwegian Akutt nekrotoserende gingivitt, Nekrotiserende ulcerativ gingivitt, Vincents gingivostomatitt, Nekrotiserende ulcerøs gingivitt, NUG