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Caring For ANUG: Acute Necrotizing Ulcerative Gingivitis 

ANUG: acute necrotizing ulcerative gingivitis (trench mouth) is the most severe type of gingivitis.

Once you have seen or experience this type of gingivitis you will never forget it.

I have seen it a few times and always I feel nothing but compassion for those who are suffering with this painful and distressing condition.


Symptoms may  include

  • Severe gum swelling
  • Bright red gumsGums that bleed when gently touched or may even bleed spontaneously
  • White film covering gums and teeth
  • White or red ulcers that give the gum tissue between the teeth (papilla) a flat or concave appearance.
  • Fever or flu-like symptoms
  • A bad odor

Those who suffer with ANUG  almost always have a lot of plaque and dental calculus (tarter). But because their gums are so sore it's impossible to thoroughly clean the area until the infection is treated.

The pain from this condition may come on suddenly but the inflammation and infection doesn't happen overnight.


The main cause is destructive bacteria due to neglected oral health care.

The name trench mouth came from soldiers who were in the trenches for days and weeks at a time without being able to brush their teeth.  

Neglect combined with the strenuous and stressful conditions caused  "trench mouth" for some of these brave soldiers.

Given the right (or wrong)  circumstances milder cases of gingivitis can progress to this point.  

Other causes include: smoking, poor nutrition, stress and a compromised immune system.

 If there are no obvious  causes, testing may be indicated to rule out auto immune diseases.


ANUG should always be treated by a dentist.  Home remedies won't be enough.   

In every case that I have seen a deep cleaning was desperately needed.  But these gums are way too tender to touch much less clean with dental instruments and the infection makes it harder to numb the area.  

I can only imagine  how the thought of  someone touching these super sore gums may keep you from going to the dentist.

Don't worry and don't stay away, if your gums are too sore to touch. 

First things first

It's important to reduce the bacteria count and control the pain.  

Antibiotics may be prescribed along with a mouth rinse containing  chlorhexidine.

Some type of numbing rinse or pain medication may also be recommended.

Once the infection is improved it will be much more comfortable to have the area gently cleaned.  It may take more than one vista and you can be completely numb and comfortable throughout.  Learn more about deep cleaning here

Take care of yourself

It's important to take care of yourself while being treated for the condition.  It is not unusual to feel stress, anxiety and fatigue when you have acute necrotizing ulcerative gingivitis.  You may think your gums will never recover or you may be scared to see a dentist.  

  • Try not to worry,  just focus on completing each step of treatment until it is resolved.
  • Get lots of rest and take some time off 
  • Eat soft but healthy foods

It's normal to feel anxious and stressed but like any situation that feels completely overwhelming, ANUG can be treated once you take the first step of scheduling an appointment. 

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