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Antibiotics for Acute Necrotizing Ulcerative Gingivitis


Antibiotics Acute Necrotizing Ulcerative Gingivitis - acute necrotizing ulcerative gingivitis treatment - acute necrotizing ulcerative gingivitis bacteria - ANUG antibiotic

Acute Necrotizing Ulcerative Gingivitis appears with stress. College students can get it during finals and people breaking up can get it. The onset of some medical conditions such as HIV infection can cause it. Regardless of the cause, it should be treated and the cause found. People who smoke, have poor nutrition and who have dental infections are susceptible.

Necrotizing ulcerating periodontitis (NUP) is a marker of severe immunosuppression that affects gingival tissues (gums) and extends to the underlying bone or periodontium. It may or may not be distinct from necrotizing ulcerative gingivitis (NUG), which is considered to be confined to the gingiva. This discussion will focus primarily on NUP, but the microbial profiles and treatment recommendations for these two periodontal diseases are similar.

The cause of trench mouth (Acute Necrotizing Ulcerative Gingivitis or ANUG) is the abnormal overgrowth of harmful bacteria in the mouth, resulting in severe infection of the gums.

Micro-organisms that cause the trench mouth are mainly anaerobes, including Bacteroides and Fusobacterium and spirochetes. Some researches mention as cause of ANUG the combination of the Bacillus Fusiformis and the spirochete (Borrelia vincentii).

A variety of micro-organisms, including fungi, viruses and bacteria, normally exist harmlessly in every human mouth. Their population is auto-regulated as they compete with each other. External factors that disturb the balance between the various micro-organisms of the mouth, may allow to some of the harmful bacteria to grow out of control. This overgrowth causes a painful infection of the gums, which can seriously damage or destroy the periodontal tissues that support the teeth (periodontal ligament and gums).

Cause of Acute Necrotizing Ulcerative Gingivitis

Several factors can increase the risk of developing trench mouth by disrupting the normal balance of bacteria in the mouth :
  • Poor oral hygiene, that allows the build-up of dental plaque on the gums, usually contributes to the development of trench mouth.
  • Mouth or tooth infections, such as an existing untreated gingivitis can easily progress into trench mouth disease.
  • Poor nutrition reduces the ability of the body to fight the infection.
  • Weakened immune system due to other conditions like AIDS or cancer, also favors the development of Acute Necrotizing Ulcerative Gingivitis.
  • Other factors contributing to ANUG include:

  • Smoking or chewing tobacco.
  • Emotional stress.
  • Lack of sleep

Treatment of Acute Necrotizing Ulcerative Gingivitis

Treatment of Acute Necrotizing Ulcerative Gingivitis attempts to stop the infection, relieve the symptoms and restore the damaged gum tissue.

Medications. Dentists often prescribe antibiotics for ANUG treatment, in order to fight the bacterial growth and prevent infection from spreading. Over-the-counter or prescription pain relievers are also recommended, especially if the patient can not brush or floss teeth because of the pain of the gums.
Patients with Acute Necrotizing Ulcerative Gingivitis are placed on tetracycline 500mg for a week before treatment.

Antibiotic therapy (preferably narrow spectrum, to leave gram-positive aerobic flora unperturbed).

  • Metronidazole is the drug of choice, 500 mg PO BID for 7-10 days.
  • If the patient cannot tolerate metronidazole: clindamycin 150 mg QID or amoxicillin-clavulanate (Augmentin) 875 mg PO BID for 7-10 days, if no hypersensitivity or allergy to either drug exists.
  • The type of antibiotic prescribed depends upon the exact type of the bacteria. Several antibiotics have been used to treat aggressive periodontal disease. They include:
  • Penicillins
  • Tetracyclines-HCL
  • Doxycycline
  • Metronidazole
  • Ciprofloxacin
  • Clindamycin
  • Professional dental cleaning. A gentle cleaning of teeth and gums by the dentist is usually the first step in the treatment of trench mouth. The dentist will also remove any dead gum tissue. As soon as the pain is reduced the dentist will perform a more thorough cleaning procedure called tooth scaling and root planing. This procedure removes dental plaque and tartar from beneath the gumline and smooths any rough surfaces of the teeth roots.

    Oral hygiene. Following a proper daily oral hygiene routine is essential for the treatment of trench mouth. Teeth should be brushed gently with a soft toothbrush at least twice a day after very meal and flossed at least once a day. If the gums feel very painful for brushing, an antiseptic mouthwash may be used for a few days for the home treatment of ANUG, until the pain subsides enough to allow brushing and flossing. Salt water rinses and hydrogen peroxide mouthwashes can also help soothe the pain of sore gums.

    Gum surgery. If the damage to the gums is extensive, dental cleaning and oral hygiene may not be enough to restore the gum tissues. In this case, the ANUG treatment involves gum surgery (periodontal surgery) in order to restore the normal shape of the gums.

    It is recommended that during Acute Necrotizing Ulcerative Gingivitis treatment, any cause of irritation to the gums, such as smoking or eating spicy foods and drinking alcohol, should be avoided. Treatment of trench mouth with regular brushing and flossing, professional tooth cleaning and antibiotics is generally effective. In mild cases of ANUG complete healing is expected in a couple of weeks.

    Acute Necrotizing Ulcerative Gingivitis
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