Acute necrotizing ulcerative gingivitis K05.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 31.01.2023

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Acute necrotizing gingivitis; Acute necrotizing ulcerative gingivitis; Acute, necrotizing, ulcerative gingivitis; ANUG; Gingivitis, acute, necrotizing, ulcerous; Necrotizing ulcerative gingivitis

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Multifactorial, acute, ulcerous inflammation of the gingiva (see also gingivitis), which occurs more frequently in patients who are permanently or only passagantly immunocompromised (e.g. in HIV infection or after other viral diseases).

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Many different causes are described. A lack of hygiene is to be assumed as an essential etiological factor. Characteristic for the disease is also the detection of fusiform bacteria and spirochetes. The occurrence can also be combined with HIV infection.

Clinical features
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Diffuse redness and swelling of the gums with ulcerative decay. Foetor ex ore. Optional white-gray plaque. High sensitivity to pain; burning sensation. Severe general symptoms such as feeling weak and fever.

Differential diagnosis
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Ulcerous stomatitis of other genesis; drug reaction, undesirable.

General therapy
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Soft toothbrush and careful cleaning. If necessary, only rinse the gums. Porridge and liquid food. After the symptoms have subsided, dental check-ups and treatment as well as consistent hygiene of the mouth: 2 times/day tooth brushing with an interdental toothbrush and correct tooth brushing technique, toothpaste with amino fluoride/tin fluoride or sanguinaria extract, use of dental floss for mechanical interdental cleaning, occasional chewing of xylitol gum.

External therapy
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Careful cleaning of the oral mucosa with antiseptic and anti-inflammatory solutions (see dentistry below) such as 0.1-0.2% chlorhexidine gargle solution(e.g. chlorhexidine digluconate, R045 ) or ratanhia myrrh astringent, polyvidone iodine (e.g. Betaisodona oral antiseptic) or 5% dexpanthenol solution(Bepanthen, R066 ).

Internal therapy
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  • Early internal treatment with metronidazole (e.g. Clont or Flagyl) 3 times/day 400 mg for 3-7 days or amoxicillin (e.g. Amoxicillin-Heyl) 3-4 times 750 mg/day. Alternatively: Amoxicillin/Clavulanic acid 3 times/day 1000 mg p.o. In severe cases cefotaxime 2 times/day 1-2 g i.v. (max. 3 times/day 2 g or 4 times/day 3 g).
  • If necessary, analgesics such as paracetamol (e.g. ben-u-ron Supp.). Adults 2-3 times/day 1000 mg.

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After the general and local symptoms have subsided, the causes of irritation are eliminated, otherwise the disease will turn into chronic gingivitis or chronic gingivostomatitis.

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Rinse with camomile (e.g. Kamillosan, Kamillan Supra), sage (e.g. Salus Sage-Trp., Salvysat), myrrh extract (Inspirol-P-forte) or other plant extracts (e.g. Gingivitol). Cloves in their native state (bite into the mouth) or the clove oil itself have also proved to be effective.

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  1. Coogan MM, Greenspan J, Challacombe SJ (2005) Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ 83: 700-706
  2. Sucker C, Djawari J (1999) Recurrent episodes of ulcerative gingivostomatitis associated with cyclic neutropenia. dermatologist 50: 503-506


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Last updated on: 31.01.2023