Editing Toothache (section)

=====Acute necrotizing ulcerative gingivitis=====
[[File:Ulcerative necrotizing gingivitis.jpg|thumb|right|Mild presentation of ANUG on the gums of the lower front teeth]]
Common marginal [[gingivitis]] in response to subgingival plaque is usually a painless condition. However, an acute form of gingivitis/periodontitis, termed [[acute necrotizing ulcerative gingivitis]] (ANUG), can develop, often suddenly. It is associated with severe periodontal pain, bleeding gums, "punched out" ulceration, loss of the [[dental papilla|interdental papillae]], and possibly also [[halitosis]] (bad breath) and a bad taste. Predisposing factors include poor [[oral hygiene]], smoking, malnutrition, psychological stress, and immunosuppression.<ref name="Carranza11th"/>{{rp|97–98}} This condition is not contagious, but multiple cases may simultaneously occur in populations who share the same risk factors (such as students in a dormitory during a period of examination).<ref name=Lindhe2008_2>{{cite book| last1=Lindhe | first1=Jan | last2=Lang | first2=Niklaus P. | last3=Karring | first3=Thorkild|title=Clinical periodontology and implant dentistry|year=2008|publisher=Blackwell Munksgaard|location=Oxford|isbn=978-1-4051-6099-5|pages=413, 459|edition=5th}}</ref> ANUG is treated over several visits, first with [[debridement]] of the necrotic gingiva, homecare with [[hydrogen peroxide]] mouthwash, analgesics and, when the pain has subsided sufficiently, cleaning below the gumline, both professionally and at home. Antibiotics are not indicated in ANUG management unless there is underlying systemic disease.<ref name="Carranza11th">{{cite book | title=Carranza's clinical periodontology 11th edition | publisher=Elsevier Saunders | author=Newman, MG | year=2012 | location=St. Louis, Missouri | isbn=978-1-4377-0416-7}}</ref>{{rp|437–438}}