STAGE 1 ACUTE NECROTIZING ULCERATIVE GINGIVITIS TRIGGERED BY ACADEMIC STRESS AND SLEEP DEPRIVATION: A CASE REPORT

Abstract

Acute Necrotizing Ulcerative Gingivitis (ANUG) is a unique, painful periodontal infection characterized by rapid gingival necrosis and bleeding. While its overall prevalence has declined, it remains a critical clinical concern in young adults when triggered by predisposing factors that alter the host immune response. This case report aims to present the successful stepped management of Stage 1 ANUG in a young adult patient. A 19-year-old female college student presented with swollen, red, and easily bleeding gums across her entire oral cavity, accompanied by a severe burning sensation, fever, halitosis, and sore throat for one week. The patient reported severe pain that impaired her ability to brush her teeth, eat, and swallow. Social history revealed extreme psychological stress and sleep deprivation due to an upcoming final university examination, leading to poor nutritional intake and inadequate oral hygiene. Intraoral examination revealed generalized marginal gingivitis with characteristic crater-like ulcers covered by a grayish pseudomembrane along the palatal aspect of teeth 11 to 25, alongside dental calculus on the mandibular lingual surface. Random blood glucose testing was performed to rule out underlying systemic diabetes mellitus, yielding a normal result (96 mg/dL). Based on Horning and Cohen’s classification, a final diagnosis of Stage 1 ANUG was established. Initial therapeutic intervention comprised pharmacological therapy, including systemic amoxicillin (500 mg every 8 hours) as an antimicrobial agent, paracetamol (500 mg) for analgesia, dexamethasone (0.5 mg) to control acute inflammation, and 0.12% chlorhexidine gluconate mouthwash twice daily. Comprehensive patient communication, information, and education (CIE) were provided regarding oral hygiene maintenance, stress management, and nutritional intake. At the 7-day follow-up, the patient reported complete resolution of pain and burning sensations. Clinical evaluation demonstrated significant healing of the crater-like ulcers and a substantial reduction in gingival inflammation. After the acute phase was controlled, the patient transitioned to the second phase of treatment, which involved scaling and root planing (SRP) alongside rigorous oral hygiene instructions. Stage 1 ANUG can be effectively managed through a structured, stepped treatment protocol. Early empirical antimicrobial therapy combined with chemical plaque control yields rapid tissue resolution. Addressing psychological stressors and maintaining long-term supportive periodontal therapy are essential to prevent recurrence.