Necrotizing Ulcerative Gingivitis (NUG)

Necrotizing ulcerative gingivitis (NUG) is a condition affecting the gums that is caused by a bacterial infection. It is a form of periodontal (gum) disease. But unlike other forms, it typically develops quickly and causes moderate to severe pain.

"Necrotizing" means that the condition destroys tissue. "Ulcerative" refers to sores that can appear on the gums. This condition used to be known as acute necrotizing ulcerative gingivitis (ANUG) and Vincent's disease, among other names. During World War I, NUG was known as trench mouth because many soldiers in the trenches suffered from it. Some dentists may still use these terms.

Stress and heavy smoking are probably the factors that most increase risk for NUG. Some studies have found that NUG is common in students during exam periods. Stress may cause certain changes in the body's ability to deal with the bacterial infection that causes NUG.

Besides stress and smoking, other factors can increase your risk for NUG:

Poor oral hygiene

Poor nutrition

Infections of the mouth or throat

A weakened immune system

In some people, NUG may be caused by another systemic (body-wide) disease, such as AIDS.

Red, swollen gums that are painful even if no pressure is placed on them

Gums that bleed easily

Bad breath or a bad taste in the mouth

A gray film on the gums

Sores (ulcers) on the gums

Sore throat

Fever (not often)

Swollen glands in the neck

Your dentist will ask questions, including:

How long you have had symptoms

Whether you have had these symptoms before

Whether and how much you smoke

Whether you have had unusual stress in your life

Whether you have any diseases

The dentist then will examine your head and neck to check for swollen lymph glands and will examine your mouth.

NUG is different from other forms of gum disease in three ways:

The condition is quite painful, even when no pressure is placed on the gums.

The triangles of gum tissue between your teeth appear flattened or deflated and are no longer visible.

NUG develops much more rapidly than other forms of gum disease.

In some cases, a dentist will take X-rays. These can show whether bone has been lost or there is some other problem causing or contributing to your symptoms.

With prompt and thorough treatment, NUG usually can be cured within one to two weeks. If you don't get treatment or don't complete your treatment, the infection can spread. In severe cases, the infection can lead to bone loss or even tooth loss and can spread to nearby areas, including the lips, cheeks and jaw. These cases are rare, however.

You can decrease your risk of developing NUG by reducing or avoiding factors that increase risk. It's especially important to take good care of your gums and teeth. Brush and floss regularly and visit a dentist for checkups.

Successful treatment of NUG requires many visits to the dentist. At first, your dentist will try to control your symptoms. He or she will numb the area, then will remove dead tissue and tartar (calculus) from around the affected teeth.

The dentist will give you instructions, including:

Keeping the area clean at home

Rinsing with warm salt water

Using a prescription antibacterial mouthwash containing chlorhexidine

Avoiding tobacco and alcohol

If you have a severe form of NUG, your dentist may prescribe antibiotics. You will be asked to come back in one or two days for evaluation and further treatment.

By your next visit, it is likely that the symptoms of NUG will have started to subside. Your dentist will clean the area more aggressively with a process called scaling and root planing. He or she will examine your other teeth to see if any are affected and will review your home-care instructions.

You should return one or two days later for a third visit. By this time, most patients are free of symptoms. If you do not have any other gum conditions, your dentist will want to see you in a month for a follow-up examination and cleaning. If you have other problems, your dentist will suggest treatment.

Even though your symptoms may improve after the first visit, it is very important to return for follow-up appointments. If NUG is not treated adequately, the symptoms can return.

If you notice that your gums are red and painful, contact your dentist.

NUG responds very well to treatment and usually can be cured.

American Academy of Periodontology (AAP)
737 North Michigan Ave.
Suite 800
Chicago, IL 60611-6660
Phone: 312-787-5518
Fax: 312-787-3670
www.perio.org