Acute Necrotizing Ulcerative Gingivitis (ANUG)

Acute Necrotizing Ulcerative Gingivitis (ANUG)

This entity used to be called “Trench Mouth” because of its prevalence in soldiers fighting in the trenches during world war I.  It is caused by a combination of stress and poor oral hygiene.  It is characterized by red, inflamed gums which are painful to the touch and which bleed easily.  It also imparts a characteristic fetid odor to the breath.  Ordinarily, poor oral hygiene allows dental plaque, which is composed entirely of live bacteria to remain on the teeth.  It is concentrated around the necks of the teeth at the gum line.   The body guards against infection by causing the gums around the necks of the teeth (the gingiva) to become inflamed.  This means that the gums build extra blood vessels, which in turn causes them to become red and swollen.  They bleed easily when touched, but are generally fairly painless to touch.  When the plaque is cleaned off the gums, the swelling, redness and tendency to bleed disappear.

If you are concerned about bad breath, see my full page on the types of bad breath, their causes and the cures for halitosis

On the other hand, when a patient is under prolonged stress, his or her immune system becomes depressed and instead of simply becoming inflamed, the bacteria actually start to “eat” or dissolve the living gum tissue.   As the bacteria attack the living tissue, it becomes “necrotic”, or dead.  This dead tissue tends to smell pretty rank, and the patient’s breath becomes fetid.  The grayish material surrounding the teeth is composed of a mixture of dental plaque and dead gum tissue.

Today, this condition is seen mostly in persons with AIDS, or in people living in impoverished and stressful conditions.  I have seen it in AIDS patients, malnourished drug addicts and in impoverished single mothers trying to care for multiple children with little outside support.

ANUG is fairly easily treated by cleaning the teeth around the gums with hydrogen peroxide and taking penicillin.  A good dental cleaning will cure the problem for good provided the patient institutes at least minimal daily oral hygiene measures.

ANUG is not contagious.

meth_mouth_thumbFor more on ANUG and its association with Meth Mouth, click here or on the icon to the right,


Copyright 2006 Martin S. Spiller, D.M.D. courtesy of Dr. Ed Cataldo


The image above two images show what ANUG looks like just before the obvious necrotic tissue begins to appear.  Note the swollen, bulbous interproximal papillae (the points of the gums between the teeth).  Note also the seriously poor oral hygiene exhibited in all these images.


Acute Necrotizing Ulcerative Gingivitis has become more common due to the prevalence of metabolic stimulant drugs such as methamphetamine and ecstasy.  It is part of the syndrome called “meth mouth” (see the small image above) which includes ANUG as well as rampant decay.  Meth mouth has become a serious problem in prison populations.  Click on the image above to read more about the relationship of drugs to oral health.

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