Introduction: Pain, swelling, pus discharge and ulceration of gingival tissue are the most common complaints that an oral physician encounter. Most of the time, these symptoms indicate gingival or periodontal pathology. Although this scenario is very common, such cases should be investigated thoroughly. We are presenting a similar case which presented to us with pain, swelling, pus discharge, and ulceration of gingival tissue. An episode of high-grade fever, malaise, nausea, and dysphagia led us to investigate the case further, thus identifying a severe disease.
Case presentation: We present a case of acute necrotising ulcerative gingivitis (ANUG) in a 51-year-old woman with a history of diabetes and hypertension. The patient presented with a one-week history of fever and white, necrotic patches on the surface of the gingiva. Oral examination revealed halitosis, ulcerated, and painful and swollen gingiva, especially the anterior part. The differential diagnoses considered were gingival ulcers of viral origin and desquamative gingivitis. CBCT revealed mild to moderate bone loss. Lab investigation revealed underlying leukopenia, which later improved, and poorly controlled diabetic status. The case was managed by conservative oral treatment and management of the underlying systemic condition.
Conclusion: This case highlights the importance of a thorough case history and appropriate investigations in diagnosing ANUG. In addition, a successful outcome of acute necrotising gingivitis depends on a multidisciplinary approach involving an oral medicine specialist, periodontist and general physician.