Raghavendra Nagappa¹*, Kolappan Ramamoorthy², Ram Sundar Chaulagain³

¹Professor, Department of Periodontics, College of Medical Sciences, Chitwan, Nepal
²Professor, Department of Oral Medicine and Radiology, College of Medical Sciences, Chitwan, Nepal
³Lecturer, Department of Oral and Maxillofacial Surgery, College of Medical Sciences, Chitwan, Nepal

*Corresponding Author: Raghavendra Nagappa, Professor, Department of Periodontics, College of Medical Sciences, Chitwan, Nepal.

Received: June 17, 2026; Published: July 02, 2026

Acute Necrotizing Ulcerative Gingivitis (ANUG) is a rapidly progressive periodontal infection characterized by gingival necrosis, ulceration, spontaneous bleeding, pain, and fetid oral odor. Historically referred to as “trench mouth,” the disease gained prominence during World War I due to its high prevalence among soldiers exposed to poor oral hygiene, malnutrition, stress, and inadequate living conditions. ANUG is now recognized as an opportunistic polymicrobial infection associated with an imbalance of the normal oral flora, particularly fusiform bacilli and spirochetes, in susceptible individuals. Multiple local and systemic predisposing factors including smoking, emotional stress, malnutrition, immunosuppression, hematological disorders, and human immunodeficiency virus infection contribute to disease development. Clinically, the condition presents with characteristic punched-out interdental papillae covered by a gray pseudomembrane, spontaneous gingival bleeding, halitosis, excessive salivation, and severe pain. If untreated, the disease may progress to necrotizing ulcerative periodontitis, necrotizing stomatitis, or noma. Early recognition and prompt management are crucial for preventing complications and preserving periodontal health. This review discusses the epidemiology, etiopathogenesis, risk factors, microbiology, clinical manifestations, diagnosis, differential diagnosis, complications, treatment strategies, and preventive measures associated with ANUG.

Keywords: Acute Necrotizing Ulcerative Gingivitis; Trench Mouth; Necrotizing Periodontal Disease; Fusospirochetal Infection; Noma; Periodontal Infection

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Citation

Citation: Raghavendra Nagappa.,et al. “Acute Necrotizing Ulcerative Gingivitis: A Comprehensive Review of Etiopathogenesis, Clinical Features and Man- agement". Acta Scientific Dental Sciences 10.7 (2026): 70-79.

Copyright

Copyright: © 2026 Raghavendra Nagappa.,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.