Trench Mouth: Clinical Features and Treatment for Necrotizing Ulcerative Gingivitis

Trench mouth is the common name for the medical condition called necrotizing gingivitis. This disease is also popularly called as acute necrotizing ulcerative gingivitis or ANUG. But this is a misnomer as there is no chronic form of this disease exists.

NUG is also known as Vincent’s Gingivitis or Vincent’s Gingivostomatitis. This, however, shouldn’t be confused with Vincent’s angina which is entirely a different condition.

Necrotising Ulcerative Gingivitis or necrotizing gingivitis is an infection of the gums which is non-contagious in nature.

This is a microbial disease of the Gingiva which occurs in people with lower immunity. Trench mouth is characterized by the necrosis of gums and the sloughing of gum tissues. Occasionally NUG may also have associated systemic problems.

Trench Mouth Clinical Features, Signs, and Symptoms

As the name suggests, this is an acute onset disease. It starts abruptly. Trench mouth sometimes occurs after a prolonged episode of a debilitating disease or acute respiratory tract infections.

It can affect a single tooth, multiple teeth or even sometimes affect the gingiva in the whole mouth.
In advanced forms of Trench mouth, there may be the destruction of underlying Periodontal tissues and the bone, especially in people with a long-standing disease and in people who are immunocompromised. When there are periodontal tissue destructions and bone loss, the condition is called Necrotising Ulcerative Periodontitis.

trench mouth

Trench Mouth

If the necrosis in the gums spreads beyond the mucogingival junction (the place where the gum line meets the mucosal tissue in the mouth) the condition is called necrotizing stomatitis.

The trench mouth disease is characterized by the formation of punched out, crater-like depressions on the gums. These ulcerations are covered with greyish slough and are differentiated well by the surrounding normal gum area.

In some cases, the gingiva may turn entirely red and start bleeding. The gum may also bleed on a slight application of pressure.

Because of the infection, there is almost always the presence of bad breath in the person suffering. Also, the person may salivate excessively because of the disease in the mouth.

The gum in this condition is extremely sensitive to touch. The patient may often feel constant radiating, gnawing pain which may be exaggerated on eating hot and spicy food items and even after chewing. The person suffering from TRENCH MOUTH may also feel a sense of metallic taste in the mouth.

In severe cases of necrotizing ulcerative gingivitis, the person may suffer from fever and associated symptoms which are as follows.

  • Insomnia
  • Constipation
  • Gastrointestinal disorders
  • Headache
  • Mental depression

Treatment for Trench Mouth

In most cases, the symptoms of NUG reduce without any treatment. Following are some of the treatment options reserved for treating ‘Trench Mouth.’

Thorough debridement and oral prophylaxis are usually enough if there is no systemic involvement. Your dentist may ask you to rinse the mouth with 0.2% chlorhexidine Gluconate mouthwash. Following this, the dentist may perform ultrasonic scaling depending on the severity of the disease.

In some cases of Trench mouth, it becomes challenging to brush teeth because of the ulcerations on the gums. In such people, Chlorhexidine mouthwashes may be prescribed as an adjunct to tooth brushing.

If there is evidence of systemic involvement, which usually presents in the form of lymphadenopathy (pain & swelling in the associated lymph nodes)in the early stages, oral antibiotics may be required.

In most cases, it is Metronidazole 200mg tds for three days. In some instances, Penicillin may also be used.

Once the disease has regressed and ulcerations have healed, thorough dental scaling may be performed. In some very rare cases, if the gingiva has been deformed because of the craters formed during the NUG disease period, Gingivectomy may be required.

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