Acute Necrotizing Ulcerative Gingivitis Organism-Specific Therapy

Updated: Oct 21, 2020
Author: James M Stephen, MD, FAAEM, FACEP; Chief Editor: Michael Stuart Bronze, MD 

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:

  • Amoxicillin 500 mg PO TID for 10d or

  • Clindamycin 150-300 mg PO TID for 10d or

  • Doxycycline 100 mg PO BID for 10d[4]

Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans

See the list below:

  • Amoxicillin 500 mg PO TID for 10d plusmetronidazole 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) ΜΆ positive patients, consider nystatin rinse 5 mL QID orfluconazole 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]