OF all the diseases affecting humanity, gum disease is the second most prevalent, after the common cold. However, this condition is not a single entity — various kinds exist. There is a special type of gum disease, often seen mainly in individuals between 15 and 35 years old, and unlike any other, it is painful and generally severe in nature.

This infection is called acute ulcerative necrotising gingivitis (ANUG). Its sudden onset and rapid progress characterise it. The symptoms include painful gum sores and foul breath. The disease is mostly seen in people with poor oral hygiene, a weakened immune system (for example, AIDS), and psychological stress (for example, soldiers on the battlefield of war).

The gums are often red, swollen and may bleed easily, even with light pressure. Sometimes the victim experiences a metallic taste and unexplained fatigue. They may also have a low fever (37.2 to 39 degrees centigrade). When appearing in groups of people, its occurrence may be due to prevailing factors in the similar conditions under which they live.

The disease is characterised by the appearance of pain, redness, and erosions of the papillae (the projections of gum tissue between teeth). In fact, the gum line (where the gum meets the teeth) becomes necrotic and bleeds when touched.

Often, a greyish film covers the ulcer, which may eventually spread along the entire gum line. Finally, typically fetid bad breath appears that is usually obnoxious. The patient almost always complains of inability to eat due to sensible or intense pain in the gums. The type of pain experienced is a superficial ‘pressure’. Typically, the patient also experiences headaches and malaise.

Excessive secretion of saliva accompanied by a metallic taste is often noted. The lymph glands of the neck can also be detected. In advanced or severe cases, there may be generalised or systemic manifestations, including an elevated white blood cell count, gastrointestinal disturbances and an accelerated heartbeat. After healing, the papillae which have been destroyed may leave a cavernous zone, constituting an area that retains germs. This region can serve as an incubation site where the disease could erupt anytime in the future.

Most researchers believe ANUG is a primary disease caused by a fusiform bacillus (rod-shaped) in combination with a corkscrew-shaped bacterium called Borrelia vincentii. Because these two micro-organisms frequently exist in many healthy mouths, it obviously suggests that some other predisposing factor is involved in the actual case of infection.

To confirm this, researchers have never been able to induce this condition artificially in people. The most important factor that predisposes someone to contract ANUG, according to recent evidence, is lower resistance to infection, especially due to vitamin C and B complex deficiency. One author who studied the epidemic which attacked thousands of combatant soldiers during the Second World War established that this condition appeared in the presence of chronic fatigue, deficient food and precarious oral hygiene.

Without a doubt, psychologically stressful circumstances also play an important role.

The treatment of ANUG is highly variable, depending on the dentist’s individual experience with the disease. A sudden onset should be considered an emergency because, if left untreated, it may be fatal. Some prefer to treat this condition conservatively, instituting only superficial cleaning of the mouth in the initial stage, followed by scaling and polishing when the situation permits. Others opt for oxidising agents or antibiotics (metronidazole 250 mg, taken three times a day), in collaboration with local therapy (rinsing with chlorhexidine mouthwash).

In many cases, there is a marked regression within two days of treatment, even without medication. It is reported that occasionally complications of this disease can include oral gangrene, septicaemia and toxaemia (blood poisoning).