Acute Necrotizing Ulcerative Gingivitis Empiric Therapy

Empiric Therapy Regimens
Empiric therapeutic regimens for acute necrotizing ulcerative gingivitis (ANUG) are outlined below, including those for antimicrobial treatment and for adjunctive therapy.

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
Amoxicillin 500 mg PO TID for 10d plus  metronidazole 250 mg PO TID for 10d[1] 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[1]
Adjunctive therapy
Saline rinses can help to speed resolution; oral rinses with a hydrogen peroxide 3% solution may be of benefit[2]
Chlorhexidine 0.12% oral rinse 15 mL BID[3]
For human immunodeficiency virus (HIV)-positive patients, consider nystatin rinse 5 mL QID or fluconazole 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