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NUG

Today I had a patient that presented with symptoms of NUG/ANUG. Pt was 19, female, hasn’t been to the dentist in over 11 years. Enlarged, painful, bleeds easily, awful smell, thick materia alba, calculus just below the gingival margin. Pt also presented with soft, dark anterior teeth. She had more complaints about her teeth hurting from the curette than her gingiva. I used benzocaine topical and did a debridement of half of the mouth.

My question is how have others manages a patient similar to this. I have only been working in hygiene since January and this is the first case I’ve had close to NUG. Even in school I didn’t experience a patient like this. We (patient and I) discussed local for next appointment, but I fear that it won’t help much.

Please help!



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4 Answers

I had my 1st case of NUG in March, the dr actually prescribed antibiotics and perio rx to the pt to use for a week prior to coming back for debridement and it did help somewhat. I found it odd that she didn’t have me do a debridement 1st I do believe it would have been better protocol to do the debridement the rinse and antibiotics then having her return a week or two later for the rest. I guess every doctor is different

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I was instructed to go slow…everything seemed to be painful for her. The mint prophy paste burned. Curettes and water hurt her teeth and ultrasonics hurt her gums. The amount of time used (almost two full 45 min appointment slots) I had to keep stopping to make sure she was ok. She also wouldn’t communicate with me, I tried so hard to get an idea of what she was feeling.

I’ve used local on gingivitis pts on the more severe side with no luck.

I just want to be able to appropriately and effectively treat this pt. she was given rx fluoride toothpaste, peroxyl rinse samples, floss and a new brush.

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I’ve seen many patients over the years with this…some we manage a debrisment, some its impossible until a round of antibiotics and rinse…it really depends…sometimes they get a full mouth series, and prescriptions and come back for the cleaning and evaluation process…if they are too inflammed to touch its just wasting time…get that under control and treatment plan a clean up schedule…Nitrous can help get thru the initial debrisment as well…but all cases are different as well as their tolerance. .

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I have only seen one patient like this. I attempted to debride but the patient was just too sore and the topical burned. We sent her home with antibiotics, chlorhexidine and a prescription for magic mouth rinse. I told her to use the magic mouth rinse, which has lidocaine, and then take a very soft toothbrush and run it under hot water to soften it. Then just very gently brush and do as much as she was able to. She returned in a week and things did look better but I still used anesthetic to get her clean over two appointments.

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