4.07 Gingivitis
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- Prescribe (in order of preference) tetra- 
   cycline, 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
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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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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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