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Trench Mouth

By James T. Ubertalli, DMD

Trench mouth (Vincent infection or angina, acute necrotizing ulcerative gingivitis [ANUG]) is a painful, noncontagious infection of the gums, causing pain, fever, and sometimes fatigue.

  • If the normal bacteria in the mouth overgrow, the gums can become infected.

  • The gums hurt, and people have extremely bad breath.

  • A professional cleaning, sometimes followed by hydrogen peroxide rinses and antibiotics, plus good oral hygiene are effective.

The term trench mouth comes from World War I, when many soldiers in the trenches developed the infection. Trench mouth is now rare, although minor gum infections probably occur relatively commonly. The severe form usually affects only people with an impaired immune system.

The infection is caused by an abnormal overgrowth of the bacteria that normally exist harmlessly in the mouth. Poor oral hygiene usually contributes to the development of trench mouth, as do physical or emotional stress, poor diet, and lack of sleep. The infection occurs most often in people who have gingivitis and then experience a stressful event (for example, final exam week or military basic training). Trench mouth is far more common among smokers than nonsmokers.

Usually, trench mouth begins abruptly with painful gums, an uneasy feeling, excessive saliva production, and fatigue. The breath smells extremely foul. The tips of the gums between the teeth erode (wear away) and become covered with a gray layer of dead tissue. The gums bleed easily, and talking, eating, and swallowing cause pain. Often, the lymph nodes under the jaw swell, and a mild fever develops.

Diagnosis and Treatment

Because the breath smells so foul, doctors sometimes suspect the diagnosis immediately, as soon as they come into contact with affected people.

Treatment begins with a gentle, thorough, professional cleaning done over several days. Rinsing several times a day with salt water or a hydrogen peroxide solution (ordinary drugstore hydrogen peroxide mixed half-and-half with water) may be recommended instead of brushing for the first few days because of the sensitivity of the gums. People can use a soft toothbrush or washcloth to wipe the teeth. If the cleaning must be delayed (for example, if a dentist or the proper tools are not available), doctors give antibiotics (such as amoxicillin, erythromycin, or tetracycline). The infection responds very well to good oral hygiene (daily brushing and flossing). Doctors also recommend people rest, drink plenty of fluids, eat nutritious foods, and take drugs for pain. Doctors also recommend people avoid smoking or eating spicy foods.

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