Carl R. Darnall Army Medical Center - Health Library

Acute Necrotizing Ulcerative Gingivitis

(ANUG; Trench Mouth; Vincents Stomatitis)

Definition

Acute necrotizing ulcerative gingivitis (ANUG) is a serious infection of the gums that causes ulcers, swelling, and dead tissues in the mouth.

Causes  ^

Acute necrotizing ulcerative gingivitis is typically caused by excess bacteria in the mouth.

Risk Factors  ^

ANUG most often impacts people who are 35 years of age and younger. Factors that may increase the risk of ANUG include excess bacteria in the mouth due to:

  • Lack of dental care
  • Poor dental hygiene
  • Poor diet
  • Vitamin deficiencies
  • Infections in the throat, teeth, or mouth
  • A weak immune system
  • Smoking
  • Stress

Symptoms  ^

Symptoms may include:

  • Pain in the gums
  • Gums that bleed easily
  • Bad taste in the mouth; extremely bad breath
  • Red and swollen gums
  • Gray residue on the gums
  • Large ulcers or loss of gum tissue in between teeth
  • Fever
  • Discomfort
  • Swollen lymph nodes

Red and Swollen Gums
Gingivitis

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Diagnosis  ^

You will be asked about your symptoms and medical history. A dental exam will be done.

Images may be taken of your teeth and face. This can be done with x-rays.

Dental X-ray
Jaw x-ray teeth

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Treatment  ^

Although ANUG is a painful condition, it can be treated. Treatment may include:

  • Antibacterial mouthwash
  • Pain control with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
  • Dental surgery
  • Regular dental cleanings
  • Antibiotics to treat infection
  • Changes in diet

Prevention  ^

To help reduce your chances of ANUG:

  • Take proper care of teeth and gums.
  • See your dentist regularly.
  • Eat a balanced diet.
RESOURCES:

American Academy of Periodontology
http://www.perio.org

Mouth Healthy—American Dental Association
http://www.mouthhealthy.org

CANADIAN RESOURCES:

Canadian Dental Association
http://www.cda-adc.ca

Dental Hygiene Canada
http://www.dentalhygienecanada.ca

REFERENCES:

Acute Necrotizing Ulcerative Gingivitis. Merch Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/dental-disorders/periodontal-disorders/acute-necrotizing-ulcerative-gingivitis-anug. Updated June 2017. Accessed August 21, 2017.

Atout RN, Todescan, S, J Can Dent Assoc 2013;79:d46. Available at: http://www.jcda.ca/article/d46. Accessed September 18, 2017.

Last reviewed September 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP  Last Updated: 9/16/2016