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.

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.

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.

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

Doses are oral and for adults unless otherwise stated
Dosing in children quick reference dosage/weight guide
Penicillin allergy – tips on prescribing in penicillin allergy
Renal impairment dosing table
Safety in Pregnancy and Lactation
Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed November 2023