Trench Mouth

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Trench Mouth
Trench Mouth

There are certainly no prizes for guessing that the colloquial name for this unpleasant mouth condition stems from the time of the First World War when it was commonly observed in soldiers on the front line. It is by no means a recent disease and was even recorded by the ancient historian Xenaphon as being observed in Greek soldiers during the 4th century BC.

Alternative Names for Trench Mouth?

The condition was studied in detail by the eminent French physician Jean Hyacinthe Vincent in the early years of the 20th century when he described it as ulceronecrotic gingivitis. As a result, alternative names include Vincent’s infection, Vincent’s disease, Vincent’s gingivitis and Vincent’s stomatitis. There are various other alternative names such as Vicennes disease, acute membranous gingivitis, fusospirillary gingivitis, fusospirillosis, fusospirochetal gingivitis, and phagedinic gingivitis.

Bacteriologist Jean Hyacinthe Vincent
Bacteriologist Jean Hyacinthe Vincent

Trench mouth is also sometimes erroneously referred to as Vincent’s angina which is a related condition but which refers specifically to cases of bacterial tonsilitis and pharyngitis. The most commonly used medical term for this condition is acute necrotising ulcerative gingivitis (ANUG). The term necrotising ulcerative gingivitis (NUG) is also commonly used.

What is Trench Mouth?

Trench Mouth is a periodontal disease caused by a bacterial infection. The mouth normally contains a range of different bacteria along with viruses and fungi but these exist in a state of equilibrium with no adverse effects. When this balance is disturbed, some pathogenic bacteria are able to proliferate and infect the gums. In its mildest state this results in bacterial plaque and gingivitis which can usually be resolved by improved dental hygiene and specialised cleaning. In most cases, gingivitis is a chronic, slow progressing condition but rarely an acute form appears which appears rapidly and progresses very quickly. In the case of Trench Mouth, a mixture of highly damaging bacteria can be found primarily being anaerobic bacteria of the fusobacteria and spirocaete species. These result in gum infections which actually cause necrosis (death) of the skin cells. Without treatment, such infections can potentially progress to become even more serious affecting other tissues. You can see some Trench Mouth pictures below.

Trench Mouth or Necrotising Ulcerative Gingivitis (NUG)
Trench Mouth or Necrotising Ulcerative Gingivitis (NUG)

Trench Mouth Symptoms

The symptoms of Trench Mouth appear suddenly and rapidly become severe. Pain, sometimes described as “almost unbearable” is experienced. Bad breath and a bad taste in the mouth is present, the taste being described as “metallic”. The gums bleed very easily even under very minor provocation and crater-like ulcers form. The small pointed tips of the gums between the individual teeth, known as papilla, become eroded and eaten away resulting in sores and visible gaps between the teeth. The dead skin cells form a grey coloured covering to the gums which can be sloughed away revealing angry red sores beneath. Sometimes a systemic infection is present resulting in fever and fatigue. Lymph nodes of the face and neck may be swollen and painful. In most cases, Trench Mouth can be diagnosed by clinical examination but mouth swabs or blood tests may be employed in order to obtain more information about the infection or to identify any underlying causative factors. X-rays are sometimes required in order to establish the extent of the infection.

Trench Mouth Treatment

When this ailment affected soldiers of the First World War, treatment concentrated on thorough cleaning and improved dental hygiene along with a suitable mouthwash usually containing hydrogen peroxide. Today’s treatment is along similar lines but with the added advantage of modern antibiotics and other medications. Products such as ibuprofen are often adequate for pain relief and effective antibiotics include amoxicillin, erythromycin and tetracycline. Treatment is generally straightforward with a full recovery to be expected within around two weeks.

Causes of Trench Mouth

There are various factors which contribute to the likelihood of this disease occurring. The first is age and Trench Mouth usually strikes teenagers or young adults. It is rarely seen outside the age range of 15 to 35 years. Poor dental hygiene also increases the risks and it is considered that those with mild gingivitis may suddenly find that it develops into the acute form. Other infections of the teeth, mouth or throat may also be a precursor of Trench Mouth. Poor nutrition also plays a part and in some underdeveloped countries, malnutrition or poor diet results in greatly increased risks of this and other infections.

Trench Mouth or Acute Membranous Gingivitis
Trench Mouth or Acute Membranous Gingivitis

Stress, either physical or mental is often regarded as the trigger for the onset of this illness and any traumatic experience greatly increases the likelihood of an occurrence. Trench Mouth is also much more common in smokers than non-smokers. Other underlying causes include diabetes which can cause gum damage and any condition which impairs the body’s immune system including HIV/AIDS. It is hardly surprising that soldiers engaged in front-line duties were particularly vulnerable to this infection. During the First World War there were many more important things to consider, often of life and death significance, and it is reasonable to assume that in such circumstances guns would almost certainly receive a higher priority than gums!

Trench Mouth Tongue

Although Trench Mouth is normally regarded as an acute form of gingivitis affecting the gums, it is worth remembering that the same bacteria can be responsible for other mouth and throat infections. In the case of Vincent’s angina, the tonsils and pharynx are affected but lesions can also be present on the tongue. The surface of the tongue is extremely complex and certain types of sores occur on different parts of the tongue. There are many different causes of tongue sores many of which are harmless but a few of which can be very serious so any tongue sore which does clear up within a few days needs to be examined by a doctor.

Trench Mouth Home Remedies

Trench Mouth is a serious condition with the potential to become even more serious and as such always requires expert treatment. There are however a few simple measures that may help to speed up the healing process. A mouthwash can greatly assist and the best type is the one prescribed by the dentist. Other simple types may involve the use of salt water or a very dilute solution of hydrogen peroxide. Baking soda can be mixed with water to form a paste which can be applied directly to the worst lesions and is said to have antibacterial properties. Herbal teas are also said to help and the chewing of parsley allegedly helps to overcome the problems of bad breath. Foods likely to cause irritation such as peppers or hot spices should be avoided.

Treatments for Trench Mouth
Treatments for Trench Mouth include good Dental Hygiene

The most effective remedies involve lifestyle changes. Stopping smoking is the number one priority. Improved dental hygiene including brushing and flossing twice daily should prevent any recurrence and of course regular visits to the dentist can result in any minor problems being detected at an early stage. The avoidance of stressful situations can also help although this is not always possible.

Trench Mouth Prognosis

With proper treatment, a full and complete recovery is to be expected within around two weeks. By adopting a few lifestyle changes and improved dental hygiene, there is no reason to expect any recurrence. However, if Trench Mouth is left untreated, it can progress to cause the destruction of the peridontium (the tissues which support and locate the teeth) leading to tooth loss and, although rarely seen in the developed world, there is even a rare possibility that it could spread even further into other tissues such as the cheeks, lips and bones of the jaw as necrotising stomatitis or Noma, which can result in major facial deformities. Noma is a severe gangrene of the mouth which is also known as cancrum oris or fusospirochetal gangrene.

Trench Mouth – Band

In addition to being a rather unpleasant periodontal disease, some music fans may recall that “Trenchmouth” was also the name of an American rock band from Chicago that was around from 1988 until 1996 when the band members went their separate ways. Hopefully they will all continue to practice good dental hygiene ensuring that Trench Mouth remains a thing of the past.

Trenchmouth - the band!
Trenchmouth – the band!
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