by EBSCO Medical Review Board
(ANUG; Trench Mouth; Vincents Stomatitis)


Acute necrotizing ulcerative gingivitis (ANUG) is a serious infection of the gums.


The exact cause is not known. It happens when the mouth has excess bacteria in it.

Risk Factors

This problem is more common in people who are 24 years of age and younger. The risk is higher in people who have 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


A person with ANUG may have:

  • Fever
  • Red and swollen gums
  • Gums that bleed easily
  • Gum pain
  • Bad taste in the mouth or very bad breath
  • Gray buildup on the gums
  • Large sores or loss of gum in between teeth
Red and Swollen Gums
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The doctor will ask about your symptoms and health 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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Any underlying causes will need to be treated, such as improving nutrition and dental care.

The goals of treatment are to ease pain and stop the disease from getting worse. Ways to do this are:

  • Dental surgery to remove damaged tissue
  • Antibacterial mouthwash
  • Medicine to:
    • Ease pain
    • Treat infection


The risk of ANUG may be lowered by:

  • Practicing good oral hygiene
  • Eating a healthful diet
  • Managing stress


American Academy of Periodontology 

Mouth Healthy—American Dental Association 


Canadian Dental Association 

Dental Hygiene Canada 


Acute necrotizing ulcerative gingivitis. EBSCO DynaMed website. Available at: Accessed April 28, 2022.

Acute necrotizing ulcerative gingivitis. Merck Manual Professional Version website. Available at: Accessed April 28, 2022.

Revision Information

  • Reviewer: EBSCO Medical Review Board James Cornell, MD
  • Review Date: 03/2022
  • Update Date: 04/28/2022