1. Acute necrotizing Ulcerative GINGIVITIS

2. Pc of ANUG

3. Clinical features of acute necrotizing ulcerative gingivitis (ANUG)
Soreness
bleeding of the gingivae Necrosis of the gingival papillae Halitosis

4. Predisposing factors
The most common predisposing factors other than systemic ones are tobacco smoking and psychological stress, although it is by no means easy to see how these factors operate. Nicotine causes vasoconstriction of blood vessels with a consequent reduction of blood supply to the tissues and increased susceptibility to infection and damage.

5. In normal healthy patients with ANUG, spread of the infection from the gingival margins is relatively rare. In a patient weakened by debilitating disease the infection may spread to surrounding tissues. An example of the spread of ANUG in the debilitated patient is seen in cancrum oris (noma)

6. Management of ANUG
The initial treatment of ANUG comprises supragingival plaque control, and the use of a systemic antibiotic, such as metronidazole. Smokers should be advised to refrain from smoking. Patients with ANUG present with varying degrees of gingival discomfort, but in most cases it is not feasible to carry out a scale and polish at the initial visit.

7. Gentle debridement of the gingival tissues should be done and the patient given instructions to use a chlorhexidine mouthrinse and attempt gentle toothbrushing. ANUG responds rapidly to the use of penicillin, and a number of other antibiotics, but metronidazole is the usual drug of choice. A dose of 200 mg

8. Metronidazole is the antibiotic of choice for the initial management of ANUG.
Patients should be warned not to take alcohol whilst taking metronidazole.
Metronidazole is best avoided during pregnancy.