What oral antibiotics are recommended for the treatment of Vincent stomatitis (also known as acute necrotizing ulcerative gingivitis)?

Oral Antibiotics for Vincent Stomatitis (Acute Necrotizing Ulcerative Gingivitis)

Penicillin V 500 mg orally four times daily for 7-10 days is the first-line oral antibiotic for Vincent stomatitis (acute necrotizing ulcerative gingivitis), with metronidazole or tetracyclines as alternatives for penicillin-allergic patients. 1, 2

First-Line Antibiotic Therapy

• Penicillin V 500 mg orally four times daily for 7-10 days is the drug of choice for fusospirochetosis (Vincent's gingivitis and pharyngitis) according to FDA labeling 1
• Penicillin G administered parenterally or penicillin V administered orally are the antibiotics of choice for dental infections of usual etiology, including necrotizing ulcerative gingivitis 2
• The fusiform-spirochete bacteria (along with Bacteroides and Selenomonas species) that cause Vincent stomatitis are highly sensitive to penicillin 3

Alternative Antibiotics for Penicillin-Allergic Patients

• Erythromycin is the first-choice alternative for patients allergic to penicillin, though it is bacteriostatic rather than bactericidal 2
• Tetracyclines (doxycycline 100 mg twice daily) are useful third-choice agents for acute necrotizing ulcerative gingivitis when penicillin is contraindicated 2
• Metronidazole 250-500 mg four times daily provides good activity against the anaerobic bacteria involved in Vincent stomatitis 4

Essential Adjunctive Treatment (Not Optional)

Antibiotics alone are insufficient—mechanical debridement and oral hygiene are mandatory components of treatment. 5, 3

• Strict oral hygiene with mechanical bacterial control must accompany antibiotic therapy 5
• Antiseptic rinses (such as 0.2% chlorhexidine or hydrogen peroxide rinses) should be used alongside antibiotics 5, 3
• Gentle debridement of necrotic tissue is necessary after initial healing 5

When to Use Systemic Antibiotics

• Systemic antibiotics are indicated when there is systemic involvement (fever, lymphadenopathy, malaise) or when local measures alone are insufficient 3
• Antibiotics should be reserved for selected cases rather than routine use, as many mild cases respond to local measures alone 5
• Treatment should address predisposing factors including stress, inadequate sleep, poor oral hygiene, smoking, and recent illness 6, 3

Critical Clinical Pitfalls

• Do NOT confuse Vincent stomatitis with recurrent aphthous stomatitis (RAS), which does not require antibiotics and is treated with topical corticosteroids 7
• Do NOT confuse with herpes simplex stomatitis, which requires antiviral therapy (acyclovir), not antibiotics 8, 9
• The diagnostic triad for necrotizing gingivostomatitis is: pain, interdental ulceration, and gingival bleeding—often with fetid breath and pseudomembrane formation 5
• Necessary dental care must be accomplished after acute infection control, as residual defects may require gingivectomy or gingival grafting 1, 5

Special Populations

• HIV-positive patients with necrotizing ulcerative gingivitis are clinically indistinguishable from HIV-negative cases and receive the same antibiotic treatment 6
• Patients with malnutrition or other immunocompromising conditions require aggressive treatment as the infection can progress to noma (necrotizing stomatitis) if untreated 5, 6