Necrotising Periodontal Disease (Necrotising Ulcerative Gingivitis)

Local measures are to be used in the first instance:

  • Antibiotics should only be used if there is evidence of spreading infection, systemic involvement, the person is immunocompromised or has uncontrolled diabetes.

Local Measures

  • Scaling, irrigation and oral hygiene advice.
  • Limited debridement/scaling may be tolerated in the acute phase due to pain.
  • Consider analgesia.
  • Consider the use of 0.2% chlorhexidine mouthwash until acute symptoms are relieved. Caution: very rare risk of anaphylaxis with chlorhexidine.

Comments from the Expert Advisory Group

  • Necrotising Periodontal Disease is very rare in children under 12 years of age (in the absence of immunosuppression or malnutrition). Consideration should be given to an alternative diagnosis in this age cohort.

Treatment

If antibiotics deemed clinically indicated:

NECROTISING PERIODONTAL DISEASE ANTIBIOTIC TREATMENT TABLE
Drug Dose Duration Notes
1st choice options

Metronidazole

 

 

 

 

 

 

 

1-2 years: 50mg every 8 hours

3-6 years: 100mg every 12 hours

7-9 years: 100mg every 8 hours

10-17 years: 200mg every 8 hours.

For children with severe infection (or at extremes of body weight for their age) consider 7.5mg/kg (max. 400mg) every 8 hours

Adults: 400mg every 8 hours

3 days

(5 days in severe infection or if adequate source control not achieved)

 

 

 

 

Advise patients to avoid alcohol.

Anticoagulant effect of warfarin may be enhanced by Metronidazole.

Liquid preparation available: 200mg/5ml

 

 

 

2nd choice options / If metronidazole contraindicated

Amoxicillin

 

 

 

 

 

 

 

1-11 months: 125mg every 8 hours

1-4 years: 250mg every 8 hours

5-11 years: 500mg every 8 hours

For children with severe infection (or at extremes of body weight for their age) consider 30mg/kg (max. 1g) every 8 hours

Adults and children ≥ 12 years:
500mg every 8 hours (max. 1g every 8 hours for severe infection)

3 days

(5 days in severe infection or if adequate source control not achieved)

 

 

 

 

Avoid in penicillin allergy.

Liquid preparation  available as:

125mg/5ml

250mg/5ml

 

 

 

Weight Based Dosing Tables for Analgesics in Children


Patient Information


Safe Prescribing (visit the safe prescribing page)

Reviewed November 2023

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