A 16-year-old white female experiences the sudden onset of tender, bleeding gums, malodorous breath, and a bad taste in her mouth. On examination she is febrile and has cervical lymphadenopathy and tachycardia. Her mouth has marginal punched-out, crater-like depressions of the interdental gingival papillae and gingival margins that are covered with a gray pseudomembranous slough.

The drug of choice for treating this condition is



acyclovir (Zovirax)
penicillin
clotrimazole troche (Mycelex)
ketoconazole (Nizoral)
prednisone

Vincents Angina PCN

Vincent's angina is a pharyngeal infection with an ulcerative gingivitis caused by:

* Borrelia vincentii - a spirochaete
* Fusiformis fusiformis - a Gram -ve bacillus

Acute ulcerative gingivitis occurs without an accompanying pharyngeal infection is known as Vincent's infection. Acute ulcerative gingivitis was common in the first world war when it was known as trench mouth.

The clinical features characteristic of Vincent's angina:

* most common in young patients who are generally run down

* poor oral hygiene

* smoker

* abrupt onset of:
o gingival pain and bleeding
o foul metallic taste
o halitosis
o enlarged, tender cervical lymph nodes
o fever, malaise, anorexia
o oral examination reveals punched-out, ragged gingival ulceration
o if the pharyngeal mucosa is also inflamed, then this defines Vincent's angina

Ulcerative gingivitis responds to penicillin V 500 mg / 6h PO combined with metronidazole 400 mg / 8h PO.

Because teeth brushing is very sore during an attack, the mouth should be kept clean by the use of regular mouth washes.

The patient should be told to pay careful attention to oral hygiene after the attack in order to help prevent recurrence.

Links:

* penicillins
* metronidazole