Origin, Symptoms, and Treatment of Trench Mouth

Trench mouth is a bacterial disease that manifests as inflammation, bleeding gums, and acute halitosis -- among other things. Its approach is simple though.

Written and verified by the biologist Samuel Antonio Sánchez Amador.

Last update: 15 December, 2022

Trench mouth, also known as acute necrotizing ulcerative gingivitis (ANUG), is a rare disease nowadays. The characteristic nickname comes from the fact that it used to affect wartime soldiers, due to the unhealthy conditions and habits they had to endure during conflicts.

It manifests as an acute and painful infection in which the gums bleed due to necrosis of the papillae and an overall attack on oral health. According to studies, it’s usually linked to AIDS these days. This is because acquired immunodeficiency usually causes oral conditions in 90% of these patients.

What causes it?

Trench mouth is a painful form of gum inflammation known as gingivitis. The bacterial species Bacillus fusiformis and Borrelia Vincentii are associated with the lesions presented here. They’re not the only ones though.

According to scientific studies, there are four zones in the affected region:

• The bacterial zone is a large mass of bacteria with distinct morphologies and characteristics. These aren’t necessarily harmful at first but their excessive proliferation causes the disease.
• A zone rich in neutrophils, the most abundant leukocytes in the blood and one of the first to reach infectious foci. These are part of the pus and are present, in this case, in the bacterial zone.
• The necrotic zone is where cell death occurs. Spirochetes, a type of bacteria with an elongated, helical shape, dominate here.
• Spirochetal infiltration happens in the last layer, in which spirochetes infiltrate and there are no other types of bacteria.

As per the U.S. National Library of Medicine, the following factors can trigger the bacterial overgrowth that causes trench mouth: stress, poor oral hygiene, smoking, malnutrition, and a weak immune system.

To know more: Burning Mouth Syndrome: Identification and Treatment

What are the symptoms of trench mouth?

The MSD manual states that the infection usually begins suddenly, with pain and bleeding gums plus excessive salivation. Some of the most common clinical signs are as follows:

• Bad breath, conspicuous for its unpleasant odor
• Crater-like ulcers between the teeth
• Fever
• Unpleasant taste in the mouth, perceptible by the patient himself (some describe it as a metallic taste)
• Grayish films on the gums that appear reddened and bloody

The patient will have difficulty performing common activities such as speaking, eating, and swallowing due to these symptoms. The lymph nodes in the neck also often swell in response to the infection (lymphadenopathy).

Possible complications

Given the difficulty eating and living normally, other common complications are weight loss, dehydration, and loss of teeth. It’s possible for bacteria to infiltrate the blood if a person with this condition ignores these clinical signs, which leads to bacteremia.

The spread of infection can be devastating as it affects multiple organs and, in addition, there’s septic shock. This happens when the body overreacts and the blood pressure drops.

Diagnosis

As indicated by the scientific portal Drugs, the physical examination is the first step in detecting trench mouth. The professional will look for ulcers, grayish plaques around the teeth, and the destruction of gingival tissue. Diagnosis is usually quick and there’s little room for error.

A doctor may require blood tests and x-rays, the latter is for assessing the amount of damage caused by the infection, as the extent of the lesions is evident. The approach will depend on the severity of the clinical picture.

When to seek medical help?

Any type of gum inflammation requires medical intervention and not all of them are due to infections. However, you must rule out disease in a timely manner.

An oral infection can worsen considerably if not addressed in time because bacteria can enter the bloodstream.

Available treatments for trench mouth

According to the health portal Siegfried Rhein, the goals of treatment are to cure the infection and relieve symptomatological discomfort. People can do this through the use of antibiotics, but the main pillars of trench mouth are:

• Professional cleaning, slowly and thoroughly, over several consecutive days. This disease usually responds well to deep oral hygiene.
• The patient should perform periodic rinses with salt water or hydrogen peroxide solution at home.
• Doctors usually advise the patient to not brush their teeth, due to the fragility of the oral apparatus caused by the disorder. After rinsing and cleaning, they must brush them for the rest of their life to prevent a recurrence.

Prevention

This is simple and based on good nutrition, proper oral hygiene, and regular visits to the dentist for check-ups. Professionals also recommend that patients remain active and quit smoking.

In addition to all this, trench mouth has an important psychological component, as it’s related to stress in many cases. For this reason, the patients must sometimes seek help beyond the pharmacological field to address pathologies such as this.

Trench mouth has almost disappeared

This disease isn’t as common as it used to be, as personal hygiene standards continue to increase. You must brush your teeth every day and visit your dentist periodically. This is so they can evaluate possible maladjustments in order to prevent it.