Acute necrotizing ulcerative gingivitis (ANUG), also known as Vincent angina or trench mouth, is commonly seen in HIV patients. It is a distinct and rapidly progressive ulceration typically starting at the tip of the interdental papilla, spreading along the gingival margins, eventually destroying the periodontal tissue. The triad associated with ANUG is oral pain, halitosis, and ulcerations. Other signs and symptoms include “metallic taste,” “wooden teeth” sensation, tooth mobility, fever, adenopathy, and malnutrition. The cause of this aggressive, destructive process in HIV patients is a polymicrobial infection by oral anaerobes (Treponema, Selenomonas, Fusobacterium, Porphyromonas, Prevotella). ANUG represents a spectrum of disease from mild ulcerations to severe cellulitis and spread of the infection to the soft tissues, cheeks, lips, and bones.
ANUG is most frequently seen in four population groups: (1) HIV patients, (2) malnourished children, (3) young adults who are under a great deal of stress, and (4) polysubstance abusers. The first steps for the emergency physician are to eliminate other potentially more serious life-threatening infections and to address hydration status. Treatment includes (1) eliminating contributing factors (stress, poor nutrition, poor sleep, alcohol, and tobacco use), (2) chlorhexidine rinses twice a day, (3) surgical debridement by an oral surgeon if needed, and (4) oral penicillin and metronidazole.