Trench Mouth

Overview

What is trench mouth?

Trench mouth is a quickly progressing infection of the gums marked by bleeding, swelling, pain, ulcers between the teeth and death to gum tissue. The possibility of death (necrosis) to the teeth’s supporting structures makes trench mouth a more advanced and serious form of gingivitis, a common type of gum disease.

Although the disease was documented as early as the 4th century B.C., the term “trench mouth” came into use during World War I when soldiers in battlefield trenches suffered from poor oral hygiene, intense psychological stress, and poor diet, leading them to develop severe infections of the gums. More scientific names for the condition are necrotizing ulcerative gingivitis or necrotizing ulcerative periodontitis.

How common is trench mouth?

Trench mouth is not a common disease, affecting about 0.5% to 1% of the population. It shows an increased incidence among those who have immune system disease, particularly those who are HIV-positive. It is also more common in areas of the world where poor living conditions can prevent easy access to the tools and practices of good dental hygiene. As in the past, it is also still found frequently among soldiers.

Who is affected by trench mouth?

Young adults age 18-30 are most affected.

Symptoms and Causes

What are the symptoms of trench mouth?

  • Sudden appearance and rapid progression of intense gum pain, in either a limited or a large area
  • Ulcers of the papillae, the small projections of skin between the teeth
  • Yellow-white or gray membrane covering the ulcerated papillae
  • Death to gum tissue
  • Easily bleeding gums
  • Extremely bad breath
  • Swollen lymph glands (which would indicate a more severe or advanced state of the disease)
  • Fever
  • Fatigue

Diagnosis and Tests

How is trench mouth diagnosed?

  • Investigation of medical history, including diet and overall health habits
  • Medical consultation if the patient has an impaired immune system
  • Dental history, focusing especially on pain symptoms
  • Checking for swollen lymph glands in the head and neck area
  • Checking inside the mouth for signs of infection and swelling, and for pasty saliva
  • Detecting certain kinds of bacteria known to cause trench mouth, including fusiform bacteria (tapered at each end), Prevotella intermedia and spirochetes. However, their presence alone is not enough to diagnose trench mouth, as they may also be found in the mouths of people without the disease.

Management and Treatment

How is trench mouth treated?

There are four stages in the treatment of trench mouth:

Stage One – Stop progression of the disease, and control feelings of discomfort and pain.

  • Removal (debridement) of dead tissue from affected areas using an ultrasonic instrument or chemical agents
  • Use of oral antibiotics if the patient has a weak immune system, fever or swollen glands
  • Use of pain killers

Stage Two – Treat preexisting conditions such as gingivitis.

  • Professional cleaning of the teeth and gums, including scaling or root planing of the teeth
  • Instructing the patient on dental hygiene practices, good nutrition, appropriate fluid intake, quitting smoking and getting enough sleep
  • Use of a prescription antibacterial mouthwash twice daily

Stage Three – Surgical procedures

  • Gum surgery to fill in craters between the teeth, as necessary

Stage Four – Maintenance and support

  • Long-term monitoring to ensure that good oral hygiene practices are continued, and that the patient has control over the factors that caused the disease in the first place

What are the complications associated with trench mouth?

Without treatment, trench mouth may lead to the rapid destruction of gum tissue, and can then spread into nearby tissues such as the cheeks, lips or bones of the jaw.

Even with treatment, craters may remain between teeth and could lead to tooth loss if not corrected with gum surgery.

Some areas may not respond to treatment or may revert back to their diseased state following treatment, making tooth loss a greater possibility. Some common reasons for treatment failing to work include:

  • Failure to remove the root cause of the infection
  • Incomplete removal of dead or diseased tissue
  • Inaccurate diagnosis
  • Patient not following directions or not sticking to the prescribed course of action
  • Underlying medical issues

Prevention

Can trench mouth be prevented?

Trench mouth is preventable by following a daily schedule of flossing and brushing the teeth as recommended by dental authorities.

It is also important to maintain generally good health such as resolving psychological stress, getting enough sleep, eating nutritious meals and not smoking, so that the immune system is strong and able to fight off infection.

Who is at risk of developing trench mouth?

The following factors can make a person more likely to get trench mouth, as they interfere with the body’s immune system response:

Outlook / Prognosis

What is the outlook/prognosis for patients with trench mouth?

Some patients may not respond to treatment for trench mouth, or may have the disease return following treatment. Additional treatments or more investigation into the patient’s overall medical condition may be needed in such cases.

Frequent visits to an oral healthcare provider for maintenance and checkups, along with strict oral hygiene practices are a must for anyone who has had trench mouth.

When treatment is received in time the progression of trench mouth can usually be halted quickly, and any damage to gum tissue can be repaired before tooth loss occurs.

Last reviewed by a Cleveland Clinic medical professional on 05/01/2018.

References

  • Todescan S, Atout RN. Managing Patients with Necrotizing Ulcerative Gingivitis. J Can Dent Assoc. 2013; 79:d46. Accessed 11/18/2021.
  • Malek R, Gharibi A, Khlil N, Kissa J. Necrotizing Ulcerative Gingivitis. Contemp Clin Dent. 2017 Jul-Sep; 8(3): 496-500. Accessed 11/18/2021.
  • Mizrahi Y. NUG – necrotizing ulcerative gingivitis: a review. Refuat Hapeh Vehashinayim (1993). 2014 Jul;31(3):41-7, 62. Accessed 11/18/2021.
  • Merck Manuals. Trench Mouth. (https://www.merckmanuals.com/home/mouth-and-dental-disorders/periodontal-diseases/trench-mouth) Accessed 11/18/2021.

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