Question:
I'm helping a computer-illerate friend who was recently diagnosed with
acute NUG by her dentist. The doctor had misdiagnosed first with
strep throat and then with mono.
She has now been taking the following for 5 days:
Amoxicillin 500mg (3 times daily)
Flagyl 250mg (3 times daily)
Chlorhexidine 0.12% rinse (3 times daily)
Although she feels much better, on a follow-up visit yesterday, the
dentist yesterday said he thought it wasn't healing as fast as it
should. He has only seen 3 cases of acute NUG in his 25 years as a
dentist. This has really scared my friend.
She is a healthy girl that eats well. She doesn't buy the fact that
stress has caused this and she fears this could be symptomatic of
something else. What really freaked her out is that NUG is quite
common with HIV-infected people. Some research we have done has also
indicated HIV as common to this disorder. Even though she is not in
the high risk group for HIV, she thinks she should get tested for HIV.
I'm hoping anybody out there has some advice for her. Should she be
worried about HIV? What type of people get NUG?
Answer:
NUG has no direct relationship to HIV, and has also been known as
Vincent's infection, trenchmouth, and probably a bunch of other monikers.
I heard it described once as "shmutz pyorrhea", which is a much less than
precise clinical designation, although quite evocative.
Generally it has been related to strep, but in these cases it is
likely that cultures will give a whole constellation of bugs. I would
certainly not think it is sufficient reason to be concerned about HIV,
though an HIV test might calm your friend's mind.
ANUG is, of course, associated with poor oral hygiene. In my
experience, it is also associated strongly with smoking. Statistically,
it is said to be stress related, and is usually seen when the seasons are
changing (like now), or in students around exam time. Usually the gums
are extremely tender and thus difficult to keep clean. The smell is
usually really bad. In severe cases the pharynx is involved, and in these
cases there is often a fever.
The treatment is not inappropriate (perhaps overly aggressive if
there's no fever). The teeth should be gently cleaned by the dentist when
able (may be too sore right now). There is also a strong tendency for
these cases to recur, and then there could be permanent destruction of the
papillae (wedge-shaped points of gum tissue between the teeth), so
thorough instruction and adherence to good oral hygiene is a good idea.
I might just add that diagnosis of mono by a dentist is treading close
to practicing medicine without a license. If your friend really suspects
she may be suffering from mono or strep throat, I'd go to my physician for
follow up--and you may quote me on that!
