Etiology
Acute, aggressive periodontal condition caused by anaerobic bacteria (Prevotella, Fusobacterium, Spirochetes). Associated with stress, immunosuppression, poor oral hygiene, smoking, and malnutrition.
Clinical Presentation
- Ulceration: Necrotic ulcers on interdental papillae and marginal gingiva
- Spontaneous bleeding: Severe, often profuse
- Pain: Severe, spontaneous pain
- Halitosis: Foul odor (characteristic)
- Pseudomembrane: Yellow-gray slough covering ulcers
- Systemic symptoms: Fever, malaise, lymphadenopathy
- Rapid onset: Develops suddenly over days
Differential Diagnosis
- Aphthous ulcers (smaller, less painful)
- Herpes simplex (vesicles, not ulcers)
- Candidiasis (white coating, not ulcers)
- Chronic periodontitis (slower onset)
Management Protocol
1. Immediate Management
- Gentle debridement: Remove necrotic tissue with gauze (DO NOT aggressive scaling)
- Saline rinse: Warm saline rinses 3-4 times daily
- Pain management: Topical anesthetics for comfort
- Stress reduction: Advise rest and stress management
- Smoking cessation: Strongly advise to stop smoking
2. Antibiotic Therapy (MANDATORY)
First-Line Treatment:
| Antibiotic |
Dose |
Frequency |
Duration (Days) |
Notes |
| Metronidazole |
400mg |
Three times daily (TDS) |
7-10 days |
First choice - anaerobic coverage |
| Amoxicillin + Metronidazole |
500mg + 400mg |
TDS (both) |
7-10 days |
Combination for severe cases |
Alternative Antibiotics (if allergic):
| Antibiotic |
Dose |
Frequency |
Duration (Days) |
Indication |
| Clindamycin |
300-400mg |
Three times daily (TDS) |
7-10 days |
Penicillin allergy, good anaerobic coverage |
| Erythromycin + Metronidazole |
500mg + 400mg |
TDS (both) |
7-10 days |
Penicillin allergy |
3. Adjunctive Medications
| Medication |
Dose |
Frequency |
Duration (Days) |
Purpose |
| Chlorhexidine Rinse |
0.12% |
Twice daily |
14-21 days |
Antimicrobial rinse |
| Hydrogen Peroxide Rinse |
1-3% |
3-4 times daily |
7-10 days |
Debridement, antimicrobial |
| Ibuprofen |
400-600mg |
Three times daily |
5-7 days |
Anti-inflammatory, pain relief |
| Topical Anesthetic (Benzocaine) |
20% gel |
As needed |
During acute phase |
Pain management |
4. Nutritional Support
Protein & Amino Acids - Tissue Repair
| Food Source |
Portion |
Protein Content |
Additional Benefits |
| Chicken breast (cooked) |
3 oz (85g) |
26g |
Lean, easily digestible |
| Eggs (cooked) |
1 large |
6g |
Complete amino acids |
| Greek yogurt (plain) |
1 cup (227g) |
20g |
Probiotics, calcium |
| Lentils (cooked) |
1 cup (198g) |
18g |
Plant-based, fiber |
| Fish (salmon, cooked) |
3 oz (85g) |
19g |
Omega-3, anti-inflammatory |
Vitamin C - Immune Support & Collagen Formation
| Food Source |
Portion |
Vitamin C Content |
Additional Benefits |
| Guava |
1 medium |
165mg |
Highest Vitamin C source |
| Orange juice (fresh) |
1 cup (240ml) |
97mg |
Easily absorbed |
| Papaya |
1 cup (145g) |
88mg |
Digestive enzymes |
| Kiwi |
1 medium |
64mg |
Antioxidant |
| Tomato juice |
1 cup (240ml) |
45mg |
Lycopene, easy to consume |
Soft Foods (Easy to Consume During Acute Phase)
| Food |
Preparation |
Nutritional Value |
| Bone broth |
Warm, sipped |
Collagen, minerals, amino acids |
| Smoothies |
Blended fruits + yogurt |
Vitamins, protein, easy to consume |
| Mashed potatoes |
Soft, with butter/olive oil |
Carbohydrates, energy |
| Soup (vegetable/chicken) |
Warm, soft ingredients |
Hydration, nutrients |
| Pudding |
Milk-based |
Calcium, protein, comfort food |
Beverages & Hydration
- Water: 8-10 glasses daily (essential for healing)
- Herbal tea (chamomile): Calming, anti-inflammatory
- Green tea: Antioxidants, immune support
- Avoid: Alcohol (interferes with antibiotics), acidic drinks
Follow-Up Care
- Review after 3-5 days (should show improvement)
- Full assessment after antibiotic course completion
- Scaling and root planing after acute phase resolves (1-2 weeks)
- Address underlying causes (stress, smoking, nutrition)
- Maintenance therapy every 3-6 months
When to Refer
- No improvement after 5-7 days of antibiotics
- Systemic symptoms worsen (fever, lymphadenopathy)
- Spread to other areas (oral antral communication)
- Immunocompromised patient
- Severe pain not controlled
Clinical Notes:
- NUG is a medical emergency - requires prompt antibiotic treatment
- This is a reference guide for distressed clinicians - use clinical judgment
- Do NOT perform aggressive scaling in acute phase
- Emphasize stress reduction and lifestyle modifications
- Consider HIV testing if patient has risk factors