Trench Mouth
May, 2002

Dear Dr. Mady: I have pretty much had bleeding gums for as long as I can remember, but for the past three months, they are very swollen and extremely painful. My doctor said that it looks like I have trench mouth and that I should see a dentist. What does he mean and should I be insulted by this description? - Tony

Dear Tony: Don't be insulted or alarmed. Trench Mouth is a slang term for a condition known as Acute Necrotizing Ulcerative Gingivitis or ANUG. It may also be known as Vincent's Infection. This is characterized as an excessively painful form of gingivitis or inflammation of the gingiva or gums. Mild, moderate or advanced periodontitis (gum disease) may exist prior to or along with ANUG.

The title "trench mouth" was derived from World War I when this condition was very common among soldiers in the trenches. It may sound like a sarcastic description, but in actuality it is not improper. It can be described as a painful bacterial infection and ulceration of the gums. It causes ulceronecrotic lesions of the papillae (gums in between the teeth). These may extend to the marginal border or edge of the gums or produce painful ulcers of the mucous membranes. If this condition is associated with HIV or an immune deficiency of some sort, it may become very destructive and cause quicker tooth loss than normal.

Although this is not a viral infection, viruses may contribute, if present, to the overgrowth of these invasive bacteria associated with ANUG. Other risk factors include, but are not limited to malnutrition, poor oral hygiene, smoking, oral infections and emotional stress. Most individuals that get ANUG are between fifteen and thirty-five years of age.

If you have any or all of the following symptoms, you may in fact have ANUG. These include swollen, bleeding gums that are painful and appear grey, crater-like ulcers in between the teeth, and severely bad breath or taste in your mouth. Along with any of these symptoms, a sore throat may exist. The important thing to realize is that if ANUG is left untreated, it will lead to tooth loss. It can also spread to the lips or cheeks.

Good oral care is the most important factor in prevention, including flossing, brushing and regular trips to your dentist. If you are a smoker, quit! Your physician or dentist may have some recommendations to assist. Try and reduce and control the stress in your life, and lastly, watch what goes into your stomach. Good nutrition starts with your mouth (consuming) and if malnourished, it may show up back in your mouth.

Treatment will involve thorough debridement and cleaning of your teeth and gums by your dentist or hygienist. You may be prescribed a special antibacterial mouthrinse and even an oral antibiotic regimen, especially if you are having fever. The ultimate goal of any treatment modality is a reduction in symptoms and possibly a cure.

Until you can see your dentist, you may want to try warm salt water rinses for relief (1/4 to ½ teaspoon of salt in approximately one cup of water). Hydrogen peroxide rinses or a mixture of half peroxide and half water may help but do not rinse more than two or three times a day for more than four days. You do not want to destroy the "good bacteria" in your mouth. As a last resort, try over the counter analgesic ointments or gels. Good Luck!

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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