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Trench mouth

Definition

Trench mouth is a painful bacterial infection that involves swelling (inflammation) and ulcers in the gums (gingiva).

Alternative Names

Vincent's stomatitis; Acute necrotizing ulcerative gingivitis

Causes, incidence, and risk factors

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

The mouth normally contains a balance of different bacteria. Trench mouth occurs when there are too many normal mouth bacteria. The gums become infected and develop painful ulcers. Viruses may be involved in allowing the bacteria to grow too much.

Risks include the following:

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

This disorder is rare. When it does occur, trench mouth most often affects persons ages 15 - 35.

Symptoms

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

Note: Symptoms often begin suddenly.

Signs and tests

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

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

There may be a gray film caused by broken down (decomposed) gum tissue. Occasionally, there may be fever and swollen lymph nodes of the head and neck.

Dental x-rays or x-rays of the face may be done to determine how severe the infection is and how much tissue has been destroyed.

This disease may also be tested for by a throat swab culture.

Treatment

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

Good oral hygiene is vital to the treatment of trench mouth. Brush and floss your teeth thoroughly as often as possible, at least twice a day and preferably after each meal and at bedtime.

Salt water rinses (1/2 teaspoon of salt in 1 cup of water) may soothe sore gums. Hydrogen peroxide, used to rinse the gums, is often recommended to remove dead or dying gum tissue.

Over-the-counter pain relievers (analgesics) may reduce your discomfort. Soothing rinses or coating agents may reduce pain, especially before eating. You may apply lidocaine to the gums for severe pain.

You may be asked to visit a dentist or dental hygienist to have your teeth professionally cleaned and to have the plaque removed, once your gums feel less tender. You may need frequent dental cleaning and examinations until the disorder is cleared.

To prevent the condition from coming back, your health care provider may give you instructions on how to:

• Maintain good general health, including proper nutrition and exercise
• Maintain good oral hygiene
• Reduce stress
• Stop smoking

Avoid irritants, including smoking and hot or spicy foods.

Support Groups

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

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

Calling your health care provider

Call the dentist if you have symptoms of trench mouth, or if fever or other new symptoms develop.

Prevention

Preventive measures include:

• Good general health
• Good nutrition
• Good oral hygiene, including thorough tooth brushing and flossing
• Learning ways to cope with stress
• Regular professional dental cleaning and examination
• Stopping smoking