4.07 Gingivitis

agk’s Library of Common Simple Emergencies

Presentation

The patient will complain of generalized severe pain of the gums, often with a foul taste or odor. The gingiva will appear edematous and red with a grayish necrotic membrane between the teeth. The gums bleed on gentle touch and there is loss of gingival tissue, especially the interdental papillae. The patient is usually afebrile and shows no sign of systemic disease.

What to do:

• Prescribe (in order of preference) tetracycline, penicillin VK or erythromycin, 250mg qid for ten days.
• Instruct the patient to use warm saline rinses, every one to two hours along with flossing and gentle brushing using sodium bicarbonate toothpaste.
• For comfort, prescribe viscous lidocaine.
• For definitive care and the prevention of periodontal disease refer the patient for dental followup care. With appropriate treatment, patients usually respond dramatically in 48-72 hours.

Discussion

Acute necrotizing ulcerative gingivitis is also known as Vincent’s angina or trench mouth. This condition is usually seen in patients who practice poor oral hygiene, are under stress, smoke, ad sometimes, have immune deficiencies. Systemic diseases that may simulate the appearance of ANUG include infectious mononucleosis, leukemia, aplastic anemia and agranulocytosis.

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