Necrotizing ulcerative gingivitis (NUG) is a condition affecting the gums that is caused by a bacterial infection resulting in a periodontal (gum) disease. But unlike other forms, it typically develops quickly and causes moderate to severe pain.

“Necrotizing” means that the condition destroys tissue. “Ulcerative” refers to sores that can appear on the gums. This condition used to be known as acute necrotizing ulcerative gingivitis (ANUG) and Vincent’s disease, among other names. It was known as trench mouth because many soldiers in the trenches suffered from it.

Stress and heavy smoking are probably the factors that most increase the risk for NUG. Some studies have found that NUG is common in students during exam periods. Stress may cause certain changes in the body’s ability to deal with the bacterial infection that causes NUG.

Besides stress and smoking, other factors can increase your risk for NUG:

• Poor oral hygiene
• Poor nutrition
• Infections of the mouth or throat
• A weakened immune system

In some people, NUG may be caused by another systemic (body-wide) disease, such as AIDS.

Symptoms

Symptoms include:

• Red, swollen gums that are painful even if no pressure is placed on them
• Gums that bleed easily
• Bad breath or a bad taste in the mouth
• A gray film on the gums
• Sores (ulcers) on the gums
• Sore throat
• Fever (not often)
• Swollen glands in the neck

Treatment

Successful treatment of NUG requires many visits for the dentist check up. At first, your dentist will try to control your symptoms. He or she will numb the area, then will remove dead tissue and tartar (calculus) from around the affected teeth.

The dentist will give you instructions, including:

• Keeping the area clean at home
• Rinsing with warm saltwater
• Using a prescription antibacterial mouthwash containing chlorhexidine
• Avoiding tobacco and alcohol

If you have a severe form of NUG, your dentist may prescribe antibiotics after your dentist check up. You will be asked to come back in one or two days for evaluation and further treatment.

By your next visit, it is likely that the symptoms of NUG will have started to subside. Your dentist will clean the area more aggressively with a process called scaling and root planning. He or she will examine your other teeth to see if any are affected and will review your home-care instructions.

You should return one or two days later for a third visit to the dentist check up. By this time, most patients are free of symptoms. If you do not have any other gum conditions, your dentist will want to see you in a month for a follow-up examination and cleaning. If you have other problems, your dentist will suggest treatment.

Even though your symptoms may improve after the first visit, it is very important to return to a dentist for follow-up dentist check up. If NUG is not treated adequately, the symptoms can return.