Acute Ulcerative Gingivitis


Acute ulcerative gingivitis which was previously known as acute necrotizing ulcerative gingivitis, trench mouth, and Vincent’s disease, is an extremely painful infection of the periodontal tissues.


Signs & Symptoms

  • It is characterized by punched out inter-dental papilla, ulcers often covered with a grayish membrane and, usually have fetid odor.
  • It is rarely associated with systemic signs and symptoms.
  • Acute ulcerative gingivitis is most commonly seen in young adult smokers.
  • It is rarely seen in children, acute herpetic gingivo-stomatitis is sometimes diagnosed as a acute ulcerative gingivitis.




  • Irrigation and debridement of the necrotic area and tooth surfaces.
  • Oral hygiene instructions, oral rinses, pain control, and management of systemic manifestations including appropriate antibiotic therapy as necessary.


  • The initial management of acute ulcerative gingivitis is usually local debridement that is scaling and root planning under local anesthesia.
  • It should be accompanied by improved plaque control with the adjunctive use of chlorhexidine mouthwash, smoking cessation counseling and metronidazole.


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When systemic signs and symptoms are present, use the following:

  • Metronidazole 400 milligram, 8 to 12 hourly for 5 days
  • Chlorhexidine 2% mouth was 10 ml rinsed in mouth for 1 minute, 8 to 12 hourly.


  • Chlorhexidine 0.12 percent mouthwash, 15 ml in mouth for 1 minute 8 to 12 hourly.
  • Metronidazole is often given as 200 milligrams orally 3 times daily, however, it is recommended as 400 mg 12 hourly. It is considered to increase patient adherence to the treatment.
  • Antibiotic therapy alone without debridement and oral hygiene improvement, invariably lead to recurrence in most cases. In an unresponsive case, in patients with HIV infection, specialist referral is indicated.
  • Acute ulcerative gingivitis can spread to involve the underlying bone, it should be treated by a specialist.


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Article written by Dr. Ajai Singh

Ref: Therapeutic guidelines 2008



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