Trench mouth

Alternative Names

Vincent's stomatitis; Acute necrotizing ulcerative gingivitis

Definition

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

Causes

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 is an overgrowth of 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.

Exams and Tests

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

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. In some cases, there may be fever and swollen lymph nodes of the head and neck.

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

This disease may also be tested for by using 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, 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. Chlorhexidine rinse will help with gum inflammation.

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 such as smoking and hot or spicy foods.

Outlook (Prognosis)

The infection usually responds to treatment. The disorder can be quite painful until it is treated. If trench mouth is not treated promptly, the infection can spread to the cheeks, lips, or jawbone and destroy these tissues.

Possible Complications

Dehydration
Loss of teeth
Pain
Periodontitis
Spread of infection

When to Contact a Medical Professional

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 exams
Stopping smoking

References

Allen CM, Camisa C. Oral disease. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 7f2.

Gingivitis and Acute Necrotizing Ulcerative Gingivitis: (Trench Mouth). In: Buttaravoli P, Leffler SM, eds. Minor Emergencies. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 50.