acute necrotizing ulcerative gingivitis

急性壊死性潰瘍性歯肉炎, ANUG

WordNet

1. of critical importance and consequence; "an acute (or critical) lack of research funds"
2. having or demonstrating ability to recognize or draw fine distinctions; "an acute observer of politics and politicians"; "incisive comments"; "icy knifelike reasoning"; "as sharp and incisive as the stroke of a fang"; "penetrating insight"; "frequent penetrative observations" (同)discriminating, incisive, keen, knifelike, penetrating, penetrative, piercing, sharp
3. extremely sharp or intense; "acute pain"; "felt acute annoyance"; "intense itching and burning" (同)intense
4. having or experiencing a rapid onset and short but severe course; "acute appendicitis"; "the acute phase of the illness"; "acute patients"
5. of an angle; less than 90 degrees
6. inflammation of the gums
7. of or relating to or characterized by ulceration; "ulcerative colitis"

PrepTutorEJDIC

1. (先の)『鋭い』,とがった / (痛み・感情などが)『激しい』,強い / (知力・感覚などが)『鋭い』,鋭敏な / (事態が)重大な / (病気が)急性の / (音が)高い,鋭い / 鋭角の
2. 歯肉炎

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/21 12:05:56」(JST)

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This article is about the physiologic disorder. For the similarly named band, see Trenchmouth.

Necrotizing ulcerative gingivitis/periodontitis
A fairly mild presentation of acute necrotizing ulcerative gingivitis at the typical site on the gums of the lower front teeth.
Classification and external resources
Specialty	Infectious disease
ICD-10	A69.1
ICD-9-CM	101
DiseasesDB	13866
MedlinePlus	001044
MeSH	D005892

Acute necrotizing ulcerative gingivitis (ANUG; colloquially known as trench mouth) is a common, non-contagious infection of the gums with sudden onset. The main features are painful, bleeding gums, and ulceration of inter-dental papillae (the sections of gum between adjacent teeth). This disease, along with necrotizing (ulcerative) periodontitis (NP or NUP) is classified as a necrotizing periodontal disease, one of the seven general types of periodontitis. The often severe gingival pain that characterizes ANUG distinguishes it from the more common chronic periodontitis which is rarely painful. ANUG is the acute presentation of necrotizing ulcerative gingivitis (NUG), which is the usual course the disease takes. If improperly treated or neglected, NUG may become chronic and/or recurrent. The causative organisms are mostly anaerobic bacteria, particularly Fusobacteria and Spirocaete species. Predisposing factors include poor oral hygiene, smoking, malnutrition, psychological stress and immunosuppression (sub-optimal functioning of the immune system). When the attachments of the teeth to the bone are involved, the term NUP is used. Treatment of ANUG is by debridement (although pain may prevent this) and antibiotics (usually metronidazole) in the acute phase, and improving oral hygiene to prevent recurrence. Although the condition has a rapid onset and is debilitating, it usually resolves quickly and does no serious harm. The synonym "trench mouth" arose during World War I as many soldiers developed the disease, probably because of the poor conditions and extreme psychological stress.

Classification

Necrotizing gingivitis is part of a spectrum of disease termed necrotizing periodontal diseases. It is the most minor form of this spectrum, with more advanced stages being termed necrotizing periodontitis, necrotizing stomatitis and the most extreme, cancrum oris. Acute necrotizing ulcerative gingivitis (ANUG) refers to the clinical onset of NUG. The word acute is used because usually the onset is sudden. Other forms of NUG may be chronic or recurrent.

Necrotizing ulcerative periodontitis (NUP) this is where the infection leads to attachment loss, and involves only the gingiva, periodontal ligament and alveolar ligament. Progression of the disease into tissue beyond the mucogingival junction characterizises necrotizing stomatitis.

Signs and symptoms

In the early stages some patients may complain of a feeling of tightness around the teeth. Three signs/symptoms must be present to diagnose this condition:

• Severe gingival pain.
• Profuse gingival bleeding that requires little or no provocation.
• Interdental papillae are ulcerated with necrotic slough. The papillary necrosis of NUG has been described as "punched out".

Other signs and symptoms may be present, but not always.

• Oral malodor (intraoral halitosis).
• Bad taste (metallic taste).

Malaise, fever and/or cervical lymph node enlargement are rare (unlike the typical features of herpetic stomatitis). Pain is fairly well localized to the affected areas. Systemic reactions may be more pronounced in children. Cancrum oris (noma) is a very rare complication, usually in debilitated children. Similar features but with more intense pain may be seen in necrotizing periodontitis in HIV/AIDS.

Causes

Necrotizing periodontal disease is caused by a mixed bacterial infection that includes anaerobes such as P. intermedia and Fusobacterium as well as spirochetes, such as Treponema.

ANUG may also be associated with diseases in which the immune system is compromised, including HIV/AIDS. ANUG is an opportunistic infection that occurs on a background of impaired local or systemic host defenses. The predisposing factors for ANUG are smoking, psychological stress, malnutrition and immunosuppression.

Zones of infection have been described. These are (superficial to deep) the bacterial zone, the neutrophil rich zone, the necrotic zone and the spirochetal zone.

Diagnosis

Diagnosis is usually clinical. Smear for fusospirochaetal bacteria and leukocytes; blood picture occasionally. The important differentiation is with acute leukaemia or herpetic stomatitis.

Treatment

Treatment includes irrigation and debridement of necrotic areas (areas of dead and/or dying gum tissue), oral hygiene instruction and the uses of mouth rinses and pain medication. If there is systemic involvement, then oral antibiotics may be given, such as metronidazole. As these diseases are often associated with systemic medical issues, proper management of the systemic disorders is appropriate.

Prognosis

Untreated, the infection may lead to rapid destruction of the periodontium and can spread, as necrotizing stomatitis or noma, into neighbouring tissues in the cheeks, lips or the bones of the jaw. As stated, the condition can occur and be especially dangerous in people with weakened immune systems. This progression to noma is possible in malnourished susceptible individuals, with severe disfigurement possible.

Epidemiology

In developed countries, this disease occurs mostly in young adults. In developing countries, NUG may occur in children of low socioeconomic status, usually occurring with malnutrition (especially inadequate protein intake) and shortly after the onset of viral infections (e.g. measles).

Predisposing factors include smoking, viral respiratory infections and immune defects, such as in HIV/AIDS. Uncommon, except in lower socioeconomic classes, this typically affects adolescents and young adults, especially in institutions, armed forces, etc., or people with HIV/AIDS. The disease has occurred in epidemic-like patterns, but it is not contagious.

History

Necrotizing ulcerative gingivitis has been observed for centuries. Xenophon observes sore mouth and foul smelling breath in Greek soldiers in the 4th century BC. Hunter describes the clinical features of ANUG in 1778, differentiating it from scurvy (avitaminosis C) and chronic periodontitis. Jean Hyacinthe Vincent, a French physician working at the Paris Pasteur Institute describes a fusospirochetal infection of the pharynx and palatine tonsils, causing "ulcero-membranous pharyngitis and tonsillitis", which later became known as Vincent's angina. Later in 1904, Vincent describes the same pathogenic organisms in "ulceronecrotic gingivitis". Vincent's angina is sometimes confused with NUG, however the former is tonsillitis and pharyngitis, and the latter involves the gums, and usually the two conditions occur in isolation from each other.

The term trench mouth evolved because the disease was observed in front line soldiers during World War I, thought to be a result at least partly because of extreme psychologic stress they were exposed to. The same condition was appearing in civilians during periods of bombing raids, who were away from the front line, and who had relatively good diets during war time due to rationing, so it is assumed that psychologic stress was the significant causative factor.

Many other historical names for this condition (and Vincent's angina) have occurred, including: "acute membranous gingivitis", "fusospirillary gingivitis", " fusospirillosis", "fusospirochetal gingivitis", "phagedenic gingivitis", "Vincent stomatitis", "Vincent gingivitis", and "Vincent infection".

In the late 1980s-early 1990s, it was originally thought that some necrotizing periodontal diseases seen in severely affected aids patients were strictly a sequela of HIV, and it was even called HIV-associated periodontitis. It is now understood that its association with HIV/AIDS was due to the immunocompromised status of such patients, and it also occurs with higher prevalence in association with other diseases in which the immune system is compromised.

References

UpToDate Contents

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• 1. 成人における歯肉炎および歯周炎：分類と歯科治療 gingivitis and periodontitis in adults classification and dental treatment
• 2. 小児および思春期における歯肉炎および歯周炎：概要 gingivitis and periodontitis in children and adolescents an overview
• 3. 歯性感染症の合併症、診断、および治療 complications diagnosis and treatment of odontogenic infections
• 4. 歯性感染症の疫学、病因、および臨床症状 epidemiology pathogenesis and clinical manifestations of odontogenic infections
• 5. Clinical manifestations, diagnosis, and treatment of diphtheria

English Journal

• Necrotizing Periodontal Diseases in Children: A Literature Review and Adjustment of Treatment.

• Marty BM1, Palmieri J2, Noirrit-Esclassan E2, Vaysse F2, Bailleul-Forestier I2.
• Journal of tropical pediatrics.J Trop Pediatr.2016 Mar 10. pii: fmw005. [Epub ahead of print]
• Necrotizing ulcerative gingivitis, sometimes observed in young children, may lead to necrotizing stomatitis and noma. Therefore, its interception is a necessity and a challenge for the paediatric practitioners. First, this article aims to propose a systematic review of recent literature on the use o
• PMID 26966241

• [Aphthous ulcers and oral ulcerations].

• Vaillant L1, Samimi M2.
• Presse médicale (Paris, France : 1983).Presse Med.2016 Feb;45(2):215-26. doi: 10.1016/j.lpm.2016.01.005. Epub 2016 Feb 12.
• Aphthous ulcers are painful ulcerations located on the mucous membrane, generally in the mouth, less often in the genital area. Three clinical forms of aphthous ulcers have been described: minor aphthous ulcers, herpetiform aphthous ulcers and major aphthous ulcers. Many other conditions presenting
• PMID 26880080

• Differential Diagnosis and Treatment Proposal for Acute Endodontic Infection.

• Keine KC1, Kuga MC2, Pereira KF1, Diniz AC3, Tonetto MR4, Galoza MO1, Magro MG1, de Barros YB4, Bandéca MC3, de Andrade MF1.
• The journal of contemporary dental practice.J Contemp Dent Pract.2015 Dec 1;16(12):977-83.
• The objective of this study was to describe the main lesions that simulate clinically and propose a treatment protocol for acute endodontic infection. Signs and clinical symptoms of periodontal abscess, gingival abscess, odontoma, herpes simplex, pericoronitis, acute pulpitis and necrotizing ulcerat
• PMID 27018033

Japanese Journal

• 三叉神経帯状疱疹に続発した歯槽骨壊死, 歯の喪失の2例

• 日本口腔外科学会雑誌 59(2), 98-102, 2013-02-20
• NAID 10031156086

• AIDS患者に生じた急性壊死性潰瘍性歯肉炎(ANUG)の1例

• 日本口腔科学会雜誌 52(6), 270-275, 2003-11-10
• NAID 10014354182

• A case of acute necrotizing ulcerative gingivitis(ANUG) in an AIDS patient

• 日本口腔科学会雑誌 52(6), 270-275, 2003
• NAID 130004335886

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★リンクテーブル★

リンク元	「急性壊死性潰瘍性歯肉炎」「ANUG」
関連記事	「acute」「necrotizing」「ulcerative」

「急性壊死性潰瘍性歯肉炎」

　　[★]

英

acute necrotizing ulcerative gingivitis, ANUG

関

ワンサン・アンギナ

「ANUG」

　　[★] 急性壊死性潰瘍性歯肉炎, acute necrotizing ulcerative gingivitis

「acute」

　　[★]

• adj.

• (疾患)急性の、急性型の、急性的な。(形状が)鋭い、鋭角の。(感覚、才知などが)鋭い。明敏な、鋭い眼識のある。

関

acutely、quick、sharp

　 　 　 　 　 　

「necrotizing」

　　[★]

• adj.

• 壊死性の

関

necrotic、necrotising

「ulcerative」

　　[★]

• adj.

• 潰瘍性の

関

ulcerous