The oral cavity is as susceptible to bacterial wrath as any other organ or system that constitutes the human body. Inflammation of the gingival tissues is the most prevalent form in which several types of gingival diseases initiate. Many a time, bacterial and host factors that lead to inflammation are modified by certain known and unknown local or systemic factors. These include varieties of oral microorganisms growing within the thin film of plaque, calculus, impaction of food and irritating dental restorations.
Nutritional deficiencies, hormonal changes associated with menstruation, pregnancy or diabetes mellitus and drug action are some of the systemic factors that ensue dental plaque induced gingival diseases. Although rare, one of the most dreaded type of gingivitis is necrotizing ulcerative gingivitis.
The latter is known by a multitude of terms for centuries, beginning with Vincent’s infection, Vincent’s stomatitis, Trench mouth, Acute necrotizing ulcerative gingivitis, Acute ulceromembranous gingivitis and Fusospirochetal gingivitis.
Etiology Of Trench Mouth
This severe form of ulceration accompanied with gingivitis was first noticed among war soldiers during the time of World War 1. As the soldiers lived in unsanitary conditions and did not have the means to look after their oral hygiene, they developed this oral condition.
Trench mouth commonly follows an epidemic pattern, sometimes surfacing post a long phase of debilitating health disorder, for example, acute respiratory tract infection. The other possible set of causes associated with this endogenous infection includes the following.
Poor nutritional intake, excessive or continued us of tobacco, protracted work sans proper physical rest, along with a great degree of pyschological stress can trigger Necrotizing ulcerative gingivitis. Psychologically stressed people have weaker body defenses and become more vulnerable to dangerous bacteria.
This polymicrobial infection that arises within the mouth causes a destructive type of gingivitis owing to simultaneous existence of many predisposing components. It is believed that a spirochete, by the name of Borrelia vincentii and a bacillus is responsible for causing this necrotic and ulcerative type of gingival inflammation. The above mentioned causative organisms coupled with a positive history of local trauma or history of HIV, mononucleosis etc puts people at a great risk of incurring Vincent’s stomatitis.
Clinical Features Of Trench Mouth
Vincent’s angina can be seen in all age groups, though maximum rate of incidence is seen in individuals belonging to the age slot of 20-30 years. The pain causing disease manifests two phases, namely acute and recurrent or sub-acute. This inflammatory condition primarily targets three structures, such as unattached (or free) marginal gingiva, crest of gingival tissue and the interdental papillae.
The hallmark feature of this disease is formation of tender, painfully distressing gingivitis with depressions on the interdental papillae. These punched out erosions or craters form all of a sudden and are covered with a thin, gray coloured, necrotic membrane. As the lesions denude from the gingival surface, the underlying gingival margin is found to be glistening and red.
Spontaneous or pronounced gingival bleeding occurs in response to even the mildest stimulation and touch. Other clinical signs include fetid odour, foul taste in the mouth, an accelerated rate of salivary flow and a severe pain that makes eating next to impossible. Also, the patient mostly complains of intensification of pain and oral discomfort on consuming hot or spicy food items.
In severe scenarios, the patient may experience high grade fever, decrease in the level of appetite and extreme lassitude, followed by mental depression and lack of sleep at night. Even the lymph nodes in the head and neck region show swelling and tenderness.
The clinical symptoms of Acute necrotizing ulcerative gingivitis develop quickly. It is best to visit a dentist as soon as any of the above features are noticed.
The dentist carefully examines the oral cavity and lymph nodes and may take radiographs to determine the extent of bone damage caused (if any). Certain tests need to be conducted to ascertain the presence of underlying medical problems that could have led to Trench mouth.
Management Of Trench Mouth
With timely diagnosis and proper treatment, patients can recoup from necrotizing disease in a matter of few weeks. The ways in which Necrotizing ulcerative gingivitis is managed varies to a significant extent (in accordance with the damage caused). Many dentists believe in treating the oral condition in a conservative manner. This covers superficial debridement of the affected oral tissues, using either warm salt water, hydrogen peroxide (in diluted concentration) or Chlorhexidine solution.
This step is always succeeded by careful, yet thorough supra and sub-gingival scaling. To do so without aggravating the pain felt by the patient, topical anaesthesia is almost always required. Other dental practitioners favour the use of antibiotic medicines in conjunction with local treatment. In cases of extensive damage to the tissues, surgery may be required later on. Once healing is complete, patient needs to maintain oral health meticulously so as to prevent recurrence.