Acute Necrotizing Ulcerative Gingivitis Empiric Therapy 

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Empiric therapeutic regimens for acute necrotizing ulcerative gingivitis (ANUG) are outlined below, including those for antimicrobial treatment and for adjunctive therapy. ^{[1, 2]}

Proper oral hygiene is the primary treatment, and referral should be made to a dentist or periodontist. Topical therapy is all that most patients will require, with systemic antibiotics being required only for patients with systemic signs of infection.

See the list below:

Amoxicillin 500 mg PO TID for 10d plus metronidazole 250 mg PO TID for 10d ^[3] or

Amoxicillin-clavulanate 500 mg/125 mg PO TID or 875 mg/125 mg PO BID for 10d or

Clindamycin 150-300 mg PO TID for 10d or

Doxycycline 100 mg PO BID for 10d ^[3]

See the list below:

Saline rinses can help to speed resolution; oral rinses with a hydrogen peroxide 3% solution may be of benefit ^[4]

Chlorhexidine 0.12% oral rinse 15 mL BID ^[5]

For human immunodeficiency virus (HIV)-positive patients, consider nystatin rinse 5 mL QID or fluconazole 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 ^[6]

Atout RN, Todescan S. Managing patients with necrotizing ulcerative gingivitis. J Can Dent Assoc. 2013. 79:d46. [Medline]. [Full Text].

Baumgartner A, Thurnheer T, Lüthi-Schaller H, et al. The phylum Synergistetes in gingivitis and necrotizing ulcerative gingivitis. J Med Microbiol. 2012 Nov. 61:1600-9. [Medline].

Walker C, Karpinia K. Rationale for use of antibiotics in periodontics. J Periodontol. 2002 Oct. 73(10):1188-96. [Medline].

Zimmer S, Kolbe C, Kaiser G, et al. Clinical efficacy of flossing versus use of antimicrobial rinses. J Periodontol. 2006 Aug. 77(8):1380-5. [Medline].

Lorenz K, Bruhn G, Heumann C, et al. Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J Clin Periodontol. 2006 Aug. 33(8):561-7. [Medline].

Taiyeb Ali TB, Waite IM. The effect of systemic ibuprofen on gingival inflammation in humans. J Clin Periodontol. Nov 1993. 20(10):723-8.

James M Stephen, MD, FAAEM, FACEP Assistant Professor, Tufts University School of Medicine; Attending Physician, Director of Graduate Education, Department of Emergency Medicine, Tufts Medical Center

James M Stephen, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Acute Necrotizing Ulcerative Gingivitis Empiric Therapy 

Research & References of Acute Necrotizing Ulcerative Gingivitis Empiric Therapy |A&C Accounting And Tax Services
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