Acute Necrotizing Ulcerative Gingivitis Organism-Specific Therapy

Updated: Oct 21, 2020
  • Author: James M Stephen, MD, FAAEM, FACEP; Chief Editor: Michael Stuart Bronze, MD  more...
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Specific Organisms and Therapeutic Regimens

Necrotizing ulcerative gingivitis is a rare disease, a study by Dufty et al finding, for example, a prevalence of 0.11% in the British armed forces. [1, 2] Organism-specific therapeutic regimens for acute necrotizing ulcerative gingivitis (ANUG) are provided below, including those for Peptostreptococci, Prevotella, Bacteroides, and Aggregatibacter actinomycetemcomitans. [3]

Peptostreptococci, Prevotella species, Bacteroides species

See the list below:

Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans

See the list below:

  • Amoxicillin 500 mg PO TID for 10d plus metronidazole 250 mg PO TID for 10d or

  • Doxycycline 100 mg PO BID for 10d or

  • Clindamycin 300 mg PO TID for 10d [5]

Adjunctive therapy

See the list below:

  • Saline rinses can help to speed resolution; oral rinses with a hydrogen peroxide 3% solution may be of benefit [6]

  • Chlorhexidine 0.12% oral rinse 15 mL BID [7]

  • For human immunodeficiency virus (HIV) ̶ positive patients, consider nystatin rinse 5 mL QID or fluconazole 200 mg PO daily for 7-14d

  • Patients with ANUG should be given a topical anesthetic and nonsteroidal anti-inflammatory drugs (NSAIDs), because pain control is very important in allowing the patient to perform good oral hygiene [8]