Overview

Trench mouth, medically known as acute necrotizing ulcerative gingivitis (ANUG), is a severe gum infection characterized by painful, bleeding gums, bad breath, and ulcerations. It is a rapidly progressing bacterial infection that causes inflammation and death (necrosis) of gum tissue. Trench mouth was historically common among soldiers in World War I who experienced poor oral hygiene in the trenches, hence the name. Today, it remains a dental emergency, especially in individuals with poor oral hygiene, high stress levels, or underlying health issues. Prompt treatment is crucial to prevent severe gum destruction and systemic complications.

Causes

Trench mouth results from an overgrowth of harmful bacteria in the mouth, typically due to poor oral care and other contributing factors:

• Poor oral hygiene: Inadequate brushing and flossing allow plaque and bacteria to accumulate along the gumline.
• High stress levels: Chronic stress can weaken the immune system, making it easier for bacteria to thrive.
• Smoking or tobacco use: Smoking reduces blood flow to the gums, impairing their ability to fight infection.
• Malnutrition: Lack of essential vitamins and nutrients, especially vitamin C, weakens gum health.
• Pre-existing gum disease: People with untreated gingivitis are more susceptible to developing trench mouth.
• Viral infections: Co-infections like herpes simplex virus may worsen symptoms.
• Weakened immune system: Conditions like HIV/AIDS, cancer treatments, or autoimmune disorders can increase risk.

Symptoms

Trench mouth presents with rapid onset of severe oral symptoms, which may include:

• Severe gum pain: Intense pain, especially when eating or brushing teeth.
• Bleeding gums: Spontaneous bleeding or bleeding with minimal touch.
• Gum ulcerations: Formation of grayish ulcers or craters along the gumline.
• Bad breath (halitosis): Foul-smelling breath due to tissue necrosis and bacterial activity.
• Swollen and red gums: Pronounced inflammation with swelling and redness.
• Fever and fatigue: In severe cases, systemic symptoms like low-grade fever and general malaise may occur.
• Metallic taste: Some individuals report a metallic or unpleasant taste in the mouth.

Diagnosis

Diagnosing trench mouth involves a thorough clinical examination by a dentist or doctor:

• Medical history: Review of oral hygiene habits, recent illnesses, stress levels, and risk factors.
• Oral examination: Inspection of the gums for ulcerations, necrosis, and characteristic grayish film.
• Plaque and tartar assessment: Checking for significant plaque buildup around teeth and gums.
• Swab tests (optional): In some cases, bacterial cultures may be taken to identify specific pathogens.
• Rule out other conditions: The dentist may rule out other causes of gum ulcers such as herpes, leukoplakia, or oral cancers.

Treatment

Trench mouth requires prompt treatment to prevent progression and relieve painful symptoms:

• Professional dental cleaning: Thorough removal of plaque and tartar by a dentist using scaling techniques.
• Antibiotics: Metronidazole or penicillin may be prescribed to control bacterial infection.
• Antiseptic mouthwash: Rinsing with chlorhexidine or hydrogen peroxide helps reduce bacterial load.
• Pain management: Over-the-counter pain relievers like ibuprofen can alleviate pain and inflammation.
• Improved oral hygiene: Brushing gently with a soft toothbrush and using floss or interdental brushes after pain subsides.
• Nutritional support: Addressing any nutritional deficiencies with supplements or dietary changes.
• Lifestyle changes: Smoking cessation and stress management can prevent recurrence.
• Follow-up care: Multiple dental visits may be required to ensure full recovery and address any gum or bone loss.

Prognosis

The prognosis for trench mouth is excellent with timely treatment:

• Rapid improvement: Symptoms often improve within days of starting antibiotics and professional cleaning.
• Prevention of complications: Early treatment prevents tooth loss, gum recession, and serious systemic infections.
• Risk of recurrence: Without proper oral hygiene and lifestyle changes, there is a risk of re-infection.
• Long-term oral health: With regular dental care and good hygiene, most people fully recover without permanent damage.

Maintaining consistent oral hygiene practices, addressing underlying health issues, and regular dental visits are key to preventing trench mouth and promoting overall oral health.