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Acute Necrotizing Ulcerative Gingivitis(ANUG; Trench Mouth; Vincent's Stomatitis)

Acute necrotizing ulcerative gingivitis (ANUG) is a serious infection of the gums that causes ulcers, swelling, and dead tissues in the mouth.


Acute necrotizing ulcerative gingivitis is typically caused by excess bacteria in the mouth.

Risk Factors

ANUG most often impacts people who are 35 years of age and younger. Factors that may increase the risk of ANUG include excess bacteria in the mouth due to:

  • Lack of dental care
  • Poor dental hygiene
  • Poor diet
  • Vitamin deficiencies
  • Infections in the throat, teeth, or mouth
  • A weak immune system
  • Smoking
  • Stress

Symptoms may include:

  • Pain in the gums
  • Gums that bleed easily
  • Bad taste in the mouth; extremely bad breath
  • Red and swollen gums
  • Gray residue on the gums
  • Large ulcers or loss of gum tissue in between teeth
  • Fever
  • Discomfort
  • Swollen lymph nodes

Red and Swollen Gums


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You will be asked about your symptoms and medical history. A dental exam will be done.

Images may be taken of your teeth and face. This can be done with x-rays.

Dental X-ray

Jaw x-ray teeth

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Although ANUG is a painful condition, it can be treated. Talk with your dentist about the best treatment plan for you. Treatment may include:

  • Antibiotics to treat infection
  • Antibacterial mouthwash
  • Pain control with nonsteroidal anti-inflamatory drugs such as ibuprofen or naproxyn
  • Dental surgery
  • Regular dental cleanings
  • Changes in diet

To help reduce your chances of getting ANUG, take the following steps:

  • Take proper care of teeth and gums.
  • See your dentist regularly.
  • Eat a balanced diet.


American Academy of Periodontology

American Dental Association


Canadian Dental Association

Canadian Dental Hygienists Association


Atout RN, Todescan, S, J Can Dent Assoc 2013;79:d46. Available at: Created April 8, 2013. Accessed August 10, 2015.

Contreras A, Falkler WA Jr, Enwonwu CO, et al. Herman herpesviridae in acute necrotizing ulcerative gingivitis in children in Nigeria. Oral Microbiol Immunol. 1997;12:259-265.

Last reviewed August 2015 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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