Trench mouth

Alternative names
Vincent’s stomatitis; Acute necrotizing ulcerative gingivitis

Definition
Trench mouth is a painful bacterial infection and ulceration of the gums (gingiva).

Causes, incidence, and risk factors

Trench mouth is a painful form of gingivitis (gum inflammation). The term “trench mouth” comes from World War I, when the disorder was common among soldiers.

The mouth normally contains a balance of different microorganisms. Trench mouth occurs when there is an overabundance of normal mouth bacteria resulting in infection of the gums, which develop painful ulcers. Viruses may be involved in allowing the bacteria to overgrow.

Risks include the following:

     
  • Poor oral hygiene  
  • Poor nutrition  
  • Throat, tooth or mouth infections  
  • Smoking  
  • Emotional stress

This disorder is rare. When it does occur, trench mouth most often affects adults younger than 35.

Symptoms

     
  • Painful gums  
  • Profuse gum bleeding in response to any pressure or irritation  
  • Gums appear reddened and swollen  
  • Grayish film on the gums  
  • Crater-like ulcers between the teeth  
  • Foul taste in the mouth  
  • Bad breath

Note: Symptoms often begin suddenly.

Signs and tests

The health care provider will examine your mouth to look for signs of trench mouth:

     
  • Inflamed gums  
  • Destruction of gum tissue around the teeth  
  • Crater-like ulcers filled with plaque and food debris.

There may be a gray film caused by decomposed gum tissue. Occasionally, fever may be present or lymph nodes of the head and neck may be swollen.

Dental X-rays or facial X-rays may be performed to determine the extent of infection and tissue destruction.

This disease may also alter the results of a throat swab culture.

Treatment

The goals of treatment are cure of the infection and relief of symptoms. Your health care provider may prescribe antibiotics if you have a fever.

Good oral hygiene is vital to the treatment of trench mouth. Thorough tooth brushing and flossing must be performed as often as possible, at least twice a day and preferably after each meal and at bedtime. Salt water rinses (one-half teaspoon of salt in one cup of water) may be soothing to sore gums. Hydrogen peroxide, used to rinse or irrigate the gums, is often recommended to remove decayed gum tissue.

Over-the-counter pain relievers (analgesics) may be used to reduce discomfort. Soothing rinses or coating agents may reduce pain, especially prior to eating. Viscous lidocaine may be used for severe pain.

You may be asked to visit a dentist or dental hygienist to have your teeth professionally cleaned, with thorough plaque removal, once your gums feel less tender. Dental cleaning and examination may be recommended on a regular, frequent basis until the disorder is cleared.

You may be given instructions regarding methods to stop smoking, reduce stress, mantain good oral hygiene, or other steps to prevent this condition from recurring. You may also be advised on how to maintain good general health, including proper nutrition and rest balanced with exercise.

Irritants must be avoided, including smoking and hot or spicy foods.

Expectations (prognosis)
The infection usually responds to treatment. The disorder can be quite painful until it is treated. If trench mouth is untreated or treatment is delayed, the infection can spread to the cheeks, lips, or jawbone and destroy these tissues.

Complications

     
  • Pain  
  • Spread of infection  
  • Loss of teeth  
  • Periodontitis  
  • Dehydration

Calling your health care provider
Call the dentist if symptoms of trench mouth occur, or if fever or other new symptoms develop in a person with this disorder.

Prevention
Good oral hygiene is important to prevent trench mouth, including thorough tooth brushing and flossing and regular professional dental cleaning and examination. Good nutrition and good general health also help to prevent the disorder. Other preventive measures include stopping smoking and learning ways to cope with stress.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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