SRUTI
ACUTE necrotising ulcerative gingivitis (ANUG) is an inflammatory destructive disease of the gums, recognised as far back as the fourth century BC among Greek soldiers. Commonly know as Vincen's Infection during the first half of the twentieth century, it most often occurs as an acute (brief, severe and of sudden onset) disease.

Who can get it?
ANUG generally attacks individuals who have had a change in living habitls, protracted work without adequate rest, psychological stress following an episode of acute respiratory track infection or as an aftermath of debilitating disease. It occurs at all ages, with the highest incidence reported between the ages of 20 and 30 years. According to a study, in India, 58 percent of the patients were younger than 10 years old.

Symptoms
A Slight elevation in temperature and local enlargement of the lympth glands are common features of the mild and moderate stages of the disease. In the severe stages, there is high fever, increased pulse rate, loss of appetite, insomnia and gastrointestinal disorders.

The person complains of a constant radiating, gnawing pain that is intensified by spicy or hot foods and chewing. There is a metallic foul taste and the person is conscious of an excessive amount of 'pasty' saliva. there are characteristic lesions in the gums, which are punched-out, creater like depressions at the crest of the gums between the teeth, subsequently extending to the marginal areas. The surface of the gingival craters is covered by a gray, pseudomembranous slough demarcated from the surrounding area by a pronounced linear redness, beneath which the margin is red, shiny and hemorrhagic.

ANUG can occur in otherwise deisease-free mouths; involvement may be limited to a single tooth or may be widespread throughout the mouth.

Clinical course
The clinical course is indefinite. The disease may subside spontaneously without treatment. Such patients generally have a history of repeated remissions and exacerbations.

ANUG can cause destruction of the supporting structures; when bone loss occurs the conditions is called necrotising ulcerative periodontitis. ANUG is caused by specific bacteria (fuso-spirochetes); diagnosis is based on clinical findings and examination of the biopy specimen to differentiate it from a multitude of similar lesions.

Treatment
Treatment entails alleviation of the acute symptomsplus control of the infection once the diagnosis is confirmed. The dentist begins with an antibiotic regimen along with supportive treatment, which consists of copious fluid consumption, nutritional supplements and analgesics and topical medications for relief of pain. Patient should avoid tobacco and alcohol. He should rinse his mouth with warm water and chlorhexidine solution twice daily. Later, the tooth surfaces in the involved areas are cleaned.

The author is a dental surgeon and can be contacted at ALL SMILES DENTAL CLINIC 6673439, 9845085230