Acute Necrotizing Ulcerative Gingivitis (ANUG)

Acute necrotizing ulcerative gingivitis (ANUG) is a painful and rapidly progressing form of gum disease that affects the gums and the tissues that support the teeth. It is also known as Vincent’s infection or trench mouth. ANUG is caused by the overgrowth of certain bacteria in the mouth that damage the gum tissue, leading to ulcers, swelling, bleeding, bad breath, and pain. The condition can be triggered by poor oral hygiene, stress, smoking, and other factors that weaken the immune system. ANUG can be treated with antibiotics, pain relief, and improved oral hygiene, but if left untreated, it can lead to severe complications such as tooth loss, bone damage, and systemic infections.


Acute necrotizing ulcerative gingivitis (ANUG) is a severe and painful bacterial infection of the gums, also known as “trench mouth.” This condition is usually caused by poor oral hygiene, stress, and a weakened immune system. Here are the main causes of ANUG:

  1. Poor oral hygiene: The buildup of plaque and food particles on the teeth and gums can lead to bacterial growth and infection. Neglecting to brush and floss regularly can create an ideal environment for bacteria to thrive.
  2. Smoking and tobacco use: Tobacco use can compromise the immune system and increase the risk of infection. Smoking also reduces blood flow to the gums, making it more difficult for the body to fight off bacteria.
  3. Stress: Chronic stress can weaken the immune system and make the body more susceptible to infection. High levels of stress can also lead to a decrease in saliva production, which can contribute to gum disease.
  4. Malnutrition: A lack of essential nutrients can weaken the immune system and increase the risk of infection. Eating a balanced diet is crucial to maintaining good oral health.
  5. Immunocompromised individuals: Certain medical conditions or treatments, such as HIV/AIDS or chemotherapy, can weaken the immune system and make individuals more susceptible to infection.
  6. Poor lifestyle habits: Excessive alcohol consumption and drug use can weaken the immune system and increase the risk of infection. Additionally, a lack of sleep and exercise can also compromise the body’s ability to fight off bacteria.

It is important to note that ANUG is a treatable condition, and seeking prompt medical attention can help prevent further complications. Treatment typically involves a thorough cleaning of the teeth and gums, antibiotics, and pain management. Maintaining good oral hygiene and leading a healthy lifestyle can also help prevent ANUG from occurring.


Acute necrotizing ulcerative gingivitis (ANUG) is a severe form of gum disease that is characterized by a range of symptoms. The main symptoms of ANUG are:

  1. Painful and bleeding gums: The gums become inflamed and painful, and there is bleeding when the teeth are brushed or when pressure is applied.
  2. Bad breath: ANUG can cause bad breath or halitosis, which is caused by the accumulation of bacteria in the mouth.
  3. Ulcers: ANUG can lead to the formation of ulcers in the gums, which are painful and can make it difficult to eat or speak.
  4. Swollen and red gums: The gums become swollen and red, which is a sign of inflammation.
  5. Pus: In severe cases of ANUG, pus may form in the gums, which is a sign of infection.
  6. Fever: ANUG can cause a low-grade fever, which is a sign that the body is fighting an infection.
  7. Difficulty eating: The ulcers and inflammation caused by ANUG can make it difficult to eat, especially if the gums are particularly painful.
  8. Swollen lymph nodes: ANUG can cause the lymph nodes in the neck to become swollen and tender.

If you experience any of these symptoms, it is important to seek medical attention as soon as possible, as ANUG can lead to serious complications if left untreated.


The diagnosis of ANUG is based on clinical symptoms and signs, which include:

  1. Painful, bleeding gums: ANUG is characterized by painful, swollen, and bleeding gums that can make it difficult to eat, speak, or perform daily activities.
  2. Ulceration of gingival tissues: ANUG can cause the gums to become ulcerated, with grayish-white patches or craters that may bleed and produce a foul odor.
  3. Bad breath: ANUG is associated with a characteristic odor that has been described as “metallic” or “rotten.”
  4. Fever: Some individuals with ANUG may develop a fever, which is a sign of infection.

To confirm the diagnosis of ANUG, a dentist or periodontist may perform a clinical examination and take a swab of the gingival tissues to culture for bacteria. In addition, dental X-rays may be taken to evaluate the extent of bone loss and identify any underlying dental issues.


The main treatment for ANUG involves the following steps:

  1. Oral hygiene: Brushing and flossing twice a day can help reduce the amount of bacteria in your mouth and prevent the spread of infection. Rinsing your mouth with warm salt water can also help reduce inflammation and relieve pain.
  2. Antibiotics: In severe cases, antibiotics may be prescribed to help kill the bacteria causing the infection. Typically, penicillin or metronidazole is prescribed for 7-10 days.
  3. Pain relief: Over-the-counter pain medications, such as ibuprofen or acetaminophen, may be recommended to help alleviate pain and discomfort.
  4. Professional cleaning: A dentist or dental hygienist may perform a professional cleaning to remove any plaque or tartar buildup, which can contribute to the development of ANUG.
  5. Surgery: In rare cases, surgery may be necessary to remove dead tissue or to reduce the size of the gum pockets around the teeth.

It is essential to maintain good oral hygiene and follow up with your dentist regularly to prevent the recurrence of ANUG.