Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Acute Necrotizing Ulcerative Gingivitis


Related Terms

  • ANUG
  • Fusospirillosis
  • Fusospirochetosis
  • Necrotizing Ulcerative Gingivitis (NUG)
  • Stomatitis
  • Trench Mouth
  • Vincent's Angina
  • Vincent's Infection
  • Vincent's Stomatitis

Differential Diagnosis

  • Adrenal insufficiency and adrenal crisis
  • Allergic reaction
  • Blood dyscrasias
  • Chronic debilitating disease
  • Fungal infection(s)
  • Gingivitis, desquamative
  • Gingivitis, diabetes mellitus
  • Gingivitis, phenytoin
  • Gingivitis, pregnancy
  • Glossitis
  • HIV/AIDS-related periodontitis
  • Inadequate plaque removal
  • Noma (cancrum oris)
  • Pericoronitis
  • Periodontitis
  • Yeast

Specialists

  • Dentist
  • Infectious Disease Internist
  • Oral/Maxillofacial Surgeon
  • Otolaryngologist

Comorbid Conditions

  • Bacterial infections
  • Immune deficiency
  • Viral infections

Factors Influencing Duration

The length of disability is influenced by the immune status of the individual, severity of disease, and treatment. Individuals with inadequate immunity suffer from systemic disease. Those with complications may have extended disability. Individuals with no access to professional dental care may have a more complicated disease and a longer recovery period.

Medical Codes

ICD-9-CM:
101 - Vincents Angina; Acute Necrotizing Ulcerative, Gingivitis, Stomatitis; Fusospirochetal Pharyngitis; Spirochetal Stomatitis; Trench Mouth; Vincents Gingivitis; Vincents Infection [Any Site]

Overview

© Reed Group
Acute necrotizing ulcerative gingivitis (ANUG) is an acute bacterial infection that causes inflammation of the gums (gingivitis). Eventually, this form of mouth inflammation (stomatitis) leads to painful open sores (ulcers) of the gums and between the teeth that may cause bad breath, increased salivation, a foul taste in the mouth, and spontaneous gum bleeding. The term trench mouth comes from World War I because ANUG was common among trench-bound soldiers. ANUG occurs when there is an overabundance of normal mouth bacteria, including fusiform bacteria and spirochetes. Although viruses may be involved in allowing the bacteria to overgrow, ANUG is not believed to be contagious. If the infection spreads to the area between the cavity of the mouth and the esophagus (oropharynx), it referred to as Vincent's stomatitis, or Vincent's angina.

Incidence and Prevalence: Gingivitis affects roughly 70% to 90% of adults (Stephen).. In other countries, gingivitis is as common as it is in the US, particularly in teenagers. Gingivitis that progresses to ANGU is rare.

Source: Medical Disability Advisor



Causation and Known Risk Factors

ANUG is a rare disease that usually affects young adults between the ages of 15 and 35, although individuals of any age may be affected. Men have an increased risk of developing gingivitis.

The primary risk factor is poor dental hygiene. Other risk factors include diabetes mellitus, poor nutrition, any other mouth, throat, or tooth infections, tobacco and/or alcohol use, emotional or physical stress, and other infections that weaken the immune system (e.g., HIV/AIDS and leukemia). Many cases develop in individuals with simple gingivitis (a common, mild gum inflammation) who experience a stressful event such as college exams or changing jobs.

Source: Medical Disability Advisor



Diagnosis

History: Individuals will complain of onset of severely painful gums that bleed profusely with any irritation or pressure, foul-smelling breath (halitosis), and a bad taste in the mouth. Eating may be painful. Fever and a vague feeling of bodily discomfort (malaise) are possible if the infection is extensive. Less commonly, individuals report unintentional weight loss or a sore throat.

Physical exam: The individual may present with red and swollen gums, with gum tissue destruction (crater-like sores) noted between and around the teeth. A grayish-white film caused by decomposed gum tissue may be evident. Ulcers that may be filled with plaque or food debris are present between teeth and on the gums. Fever and swelling of nodes in the head and neck (regional lymphadenopathy) may be noted.

Tests: Although the diagnosis is usually clinical, cultures taken from the gums can determine the species of infecting bacteria and aid in the differential diagnosis. Dental or facial x-rays may be used to determine the extent of infection below the gum line, the amount of tissue destruction, and any bone loss.

Source: Medical Disability Advisor



Treatment

Good oral hygiene is vital to treatment and should be initiated immediately. Thorough tooth brushing and flossing must be done as often as possible, preferably 3 to 4 times a day. Saltwater rinses may be soothing to sore gums. Diluted hydrogen peroxide (equal parts 3% hydrogen peroxide and water) or chlorhexidine can be used to rinse the gums and remove decayed gum tissue. Once the gums have become less tender, a thorough dental cleaning should be performed. The dentist will remove all plaque and tartar from the teeth (scaling and root planing) and clean away all dead gum tissue (debridement). This cleaning is likely to be painful so the dentist often uses a local anesthetic. After this initial cleaning, the individual may be instructed to continue rinsing with diluted hydrogen peroxide 3 times a day for a few days instead of brushing. If the infection is severe or if the individual has a fever, antibiotics may be prescribed. Pain-relieving medication (analgesics) may also be prescribed to help relieve discomfort.

The individual may be asked to return to the dentist every few days for about 2 weeks for continued cleaning. Professional cleanings continue until healing is well under way. If the gums do not return to their normal shape and position, the dentist may have to surgically reshape them (gingivoplasty).

To prevent recurrences, individuals are instructed in good oral hygiene procedures. Regular visits to the dentist for scaling and cleaning are also important. A good diet, reduction of stress, adequate sleep and exercise, and quitting smoking also help prevent recurrences. Hot or spicy foods should be avoided.

Source: Medical Disability Advisor



Prognosis

With early treatment and good follow-up care, ANUG has a favorable prognosis. Ultimately, advanced infection results in tooth loss and its attendant problems.

Systemic disease (sepsis) can develop in untreated cases of ANUG. The prognosis for these infections depends on the nature and severity of the infections at the beginning of treatment.

Source: Medical Disability Advisor



Complications

Advanced, severe, or untreated cases may result in damage to the supporting tissues and underlying bones of the mouth needed for dental health; such destruction will likely to lead to tooth loss. If the infection is allowed to progress without treatment, or if adequate follow-up is not performed, the disease can spread to the cheeks and lips, destroying these tissues (noma or cancrum oris). The bacterial infection (periodontitis) responsible for this disease may spread to other parts of the body, resulting in tissue damage to other structures. Widespread infection (sepsis) can also occur.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual may need additional breaks to perform oral hygiene. Individuals in contact with the public may need to be temporarily reassigned depending on their symptoms and appearance. Accommodations may be needed to allow for frequent visits to the dentist until the healing is advanced or completed.

Risk: Because ANUG is not a contagious disease, there is no risk to coworkers. Recurrence may be mitigated by lifestyle changes to improve the diet and oral hygiene practices. Individuals who smoke should receive counseling to quit.

Capacity: With treatment, uncomplicated ANUG is not expected to affect capacity.

Tolerance: Individuals who work with the public may feel self-conscious about their appearance and halitosis during recovery and may request temporary accommodations until the infection resolves.

Accommodations: Individuals may require frequent breaks to floss and brush their teeth and apply saltwater, hydrogen peroxide, or chlorhexidine rinses during recovery.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual have painful, bleeding gums, mouth ulcers, and halitosis?
  • Was a fever or head and neck lymphadenopathy noted in the physical exam?
  • Was a culture done to detect the causative organism and aid in the differential diagnosis?
  • Has the diagnosis of ANUG been confirmed?
  • Were other conditions with similar symptoms (e.g., other types of gingivitis, yeast and fungal infections, and periodontitis) ruled out?

Regarding treatment:

  • Has individual been compliant with recommendation to rinse the mouth 3 times daily with hydrogen peroxide or chlorhexidine? If not, why? What can be done to enhance compliance?
  • If antibiotics were prescribed, did the individual complete the entire course of therapy?
  • Has individual kept scheduled appointments for ongoing therapy? If not, what can be done to enhance compliance?
  • Was scaling and root planing, and debridement indicated?

Regarding prognosis:

  • Has the infection persisted or recurred despite treatment?
  • Does individual understand the importance of prevention? Is she or he able to comply with good dental hygiene?
  • Has individual experienced any complications, such as damage to the supporting tissues or underlying bone of the mouth?
  • Has the bacterial infection spread to other parts of the body, resulting in tissue damage to other structures?
  • Has sepsis occurred?
  • Have underlying conditions that may affect recovery (e.g., immune deficiency disorders, viral, or bacterial infections) been identified or ruled out?

Source: Medical Disability Advisor



References

Cited

Stephen, James. "Gingivitis." eMedicine. 31 Dec. 2014. Medscape. 21 Jul. 2015 <http://emedicine.medscape.com/article/763801-overview#showall>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.