Acute Necrotizing Ulcerative Gingivitis Empiric Therapy 

Updated: Dec 09, 2019
Author: James M Stephen, MD, FAAEM, FACEP; Chief Editor: Michael Stuart Bronze, MD 

Empiric Therapy Regimens

Empiric therapeutic regimens for acute necrotizing ulcerative gingivitis (ANUG) are outlined below, including those for antimicrobial treatment and for adjunctive therapy.[1, 2]

Proper oral hygiene is the primary treatment, and referral should be made to a dentist or periodontist. Topical therapy is all that most patients will require, with systemic antibiotics being required only for patients with systemic signs of infection.

Antimicrobial treatment recommendations

See the list below:

  • Amoxicillin 500 mg PO TID for 10d plusmetronidazole 250 mg PO TID for 10d[3] or

  • Amoxicillin-clavulanate 500 mg/125 mg PO TID or 875 mg/125 mg PO BID for 10d or

  • Clindamycin 150-300 mg PO TID for 10d or

  • Doxycycline 100 mg PO BID for 10d[3]

Adjunctive therapy

See the list below:

  • Saline rinses can help to speed resolution; oral rinses with a hydrogen peroxide 3% solution may be of benefit;[4]  also, over-the-counter oxygenating mouth rinses are effective[5]

  • Chlorhexidine 0.12% oral rinse 15 mL BID[6]

  • For patients who are human immunodeficiency virus (HIV) positive, consider nystatin rinse 5 mL QID orfluconazole 200 mg PO daily for 7-14d

  • Patients with ANUG should be given a topical anesthetic and nonsteroidal anti-inflammatory drugs (NSAIDs), because pain control is very important in allowing the patient to perform good oral hygiene[7]