Acute necrotizing ulcerative gingivitis (Vincent’s angina) treatment
Acute necrotizing ulcerative gingivitis (NUG), formerly referred to as acute necrotizing ulcerative gingivitis (ANUG) and clinically compatible with “Vincent’s angina,” should be treated with prompt professional management of the acute lesion to stop tissue destruction and control pain. [1]
Acute-stage management in clinic
Treatment should begin as soon as possible after diagnosis. [1]
Treatment should include: [1]
- Superficial debridement of infected areas. [1]
- Scaling and root planing as needed after initial control of the acute process. [1]
- Lavage or irrigation with an antimicrobial rinse during the acute phase. [1]
Antimicrobial rinses
Antimicrobial rinses used for intrasulcular lavage or irrigation include 0.12% chlorhexidine gluconate or 10% povidone-iodine. [1]
Rinses with hydrogen peroxide or chlorhexidine may be used during the initial days after debridement. [2]
Supportive mouth rinsing with warm normal saline is used during early management. [2]
Systemic antibiotic indications and selection
Systemic antibiotics should be used as an adjunct for severe or nonresponding disease. [1]
Preferred systemic antibiotic regimens reported in a clinical guidelines summary include metronidazole 250 mg 3 times per day for 7 to 14 days. [1]
If metronidazole cannot be tolerated, alternatives reported include clindamycin 150 mg 4 times per day or amoxicillin-clavulanate 875 mg twice per day for 7 to 10 days. [1]
If debridement is delayed, oral antibiotics effective against typical oral flora may be used to provide relief and continued until 72 hours after symptom resolution. [2]
Examples of delayed-debridement antibiotic regimens reported include metronidazole 500 mg every 8 hours or amoxicillin 500 mg every 8 hours. [2]
Supportive care and follow-up
Supportive care should include improved oral hygiene with gentle technique during the acute phase, adequate nutrition, high fluid intake, rest, and analgesics as needed. [2]
Irritation should be avoided, including smoking and hot or spicy foods. [2]
Healing should be evaluated within 7 days. [1]
Additional debridement should be performed if healing is incomplete. [1]
Reevaluation should occur at approximately 2 months to determine need for further intervention. [1]
Treatment plan for home care after acute control
Patients should receive a follow-up home-care plan that includes daily antimicrobial rinses and reinforcement of good oral hygiene maintenance after resolution of the acute disease. [1]
Definitive periodontal therapy should be provided once the acute disease is under control, including scaling and root planing as needed and treatment of any pre-existing gingivitis or periodontitis. [1]
Common pitfalls to avoid
Prophylactic systemic antibiotic therapy should be avoided because of risk of secondary oral candidiasis. [1]
Debridement should not be deferred when feasible because marked improvement is expected within 24 to 48 hours after initial debridement. [2]
Irritation factors, especially smoking, should be avoided during recovery. [2]
Targets of therapy
The treatment goal for the acute stage is elimination or reduction of the microbial load through mechanical removal of debris and plaque, combined with antimicrobial irrigation and supportive care to stop progression. [1]