Necrotizing Ulcerative Gingivitis also known as “trench mouth” is a infection of the gingiva indicated by gingival necrosis, bleeding and pain; that usually affects young adults ages 18-30 and appears most frequently in smokers. NUG is diagnosed at the onset of specific clinical signs and symptoms. NUG will appear “punched out” ulcerated papillae with gingival bleeding. During extra oral examinations one should look for lymphadenopathy of the head and neck, in addition, during intraoral examinations one might look for small, gray, ulcerative lesions that begin at the tips of the interdental papillae and spread to the gingival margin to form punched out created lesions. Note NUG can be localized or generalized with sudden onset of intense pain. The disease is caused by the overgrowth of harmful bacteria in the mouth, may also be associated with diseases in which the immune system is compromised, including HIV/AIDS. These bacteria infect the gums and damages the underlying tissues. This can later spread to throat and result in systemic infections. Abnormal growth of bacteria is initiated by factors such as poor oral hygiene, stress, smoking, poor nutrition, tooth, throat or mouth infections and weakened immune system of the body.The signs and symptoms for NUG usually last a couple days after adequate treatment. Treatments accessible: perform debridement under local anesthesia. Remove pseudo membrane using cotton pellet dipped in chlorhexidine. Advice patients with specific oral hygiene to use a prescription antibacterial mouthrise twice daily. Control pain with analgesics: ibuprofen 400-600 mg 3 times daily. Patient education should include instruction on proper nutrition, oral care, appropriate fluid intake, and smoking cessation. Prescribe antibiotics if patient is immunocompromised. Left untreated, the infection can cause destruction of the periodontium(NUP) and can even spread, into neighboring tissues in the cheeks, lips or the bones of the jaw.

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