Trench Mouth

Trench mouth is the common name for a serious infection of the mouth that extends into the gums. The proper medical name for trench mouth is acute necrotizing ulcerative gingivitis. Breaking this down, "acute" rather than chronic is a contrast largely pertaining to how long the condition lasts. Because it is acute, it will either get better (with treatment) or progress to an even more serious form involving the bones, lips or cheeks.

"Necrotizing" refers to dying tissue. The tissue involved is the gums – the soft tissue bound tightly to the teeth. The term "ulcerative" refers to a sore that dents inward. As tissue is lost, these ulcers will grow larger. When they reach deeper, the name of the condition is changed to reflect that.

Gingivitis is a term meaning an inflammation of the gums. This is the redness, swelling and tenderness that occur with trench mouth. As the condition worsens and the ulcers reach underlying tissues, the name of the disease is changed to necrotizing ulcerative periodontitis. Gingiva refers to the gum tissue only, the thin layer that lines the mouth along the jaw and teeth.

The common name, trench mouth, came from soldiers during World War I who suffered from the disease as a consequence of poor oral hygiene and the stresses of battle. This was trench warfare, and there was little time or energy expended on staying healthy amid the chaos. The name trench mouth has remained with us to this day.

Any persistent sore in the mouth should be examined by a dentist before it progresses. A foul odor or taste along with pain shouldn’t be ignored. Once the ulcers occur, they need to be treated with antibiotics, removal of dead tissue and a thorough cleaning. See below for more treatment options.

How Trench Mouth Happens

The gingiva is protected externally from infection by several mechanisms that act to inhibit growth of bacteria. However, when these mechanisms are overwhelmed, bacteria can grow into the tissue itself. The three major protections are saliva, normal bacterial flora and the integrity of the membrane.

• Saliva helps stave off infection by physical and chemical means. It moves bacteria out of the mouth and down to the stomach where they can be digested. It also contains disease fighting substances that can directly kill some bacteria. A chronically dry mouth can increase risk for trench mouth.
• Normal bacteria have evolved along with us so that they can live in the mouth without usually causing any harm. Since these “friendly” bacteria take resources from other, harmful bacteria, they serve as a way to limit growth and help keep infectious bacteria from gaining a foothold.

  The number and type of normal bacteria found in the human mouth is surprising, but expected. Over 700 different types have been detected in this warm, moist environment with a regular supply of food. There’s plenty of competition at the microscopic level.

• The membrane of the gingiva is similar to skin, although much thinner. Still, it acts as a physical barrier to keep bacteria out of the body. Just like skin, the gingiva will shed cells and renew itself when damaged – if allowed to do so. When this membrane is compromised, even normal mouth bacteria can invade and cause an infection.

While these external factors keep trench mouth at bay, there are internal defenses as well. Primarily, our immune system acts to combat infection through the blood supply. Patients with compromised immune systems then become at risk for infections, and it was once thought that only HIV patients (AIDS damages the immune response) were candidates for the more severe forms of trench mouth. This isn’t so, although a lowered immune response (as in chemotherapy or transplant patients) is one of the main causes of necrotizing ulcerative gingivitis.

How Trench Mouth Is Treated

Your dentist will be able to treat trench mouth in various ways, depending on how severe the condition is. Generally, they will start with an x-ray to determine how deep the problem goes. They will also assess your overall oral hygiene and obtain a complete medical record to look for possible underlying causes.

Most patients will be put on a regular regimen of oral hygiene (brushing and flossing) after a thorough cleaning. This can be combined with antibacterial rinses, diluted hydrogen peroxide rinses (to remove dead tissue), salt water rinses (for comfort) and even topical anesthetics (numbing agents). Pain medication may be given, as well. An oral antibiotic is sometimes prescribed to fight the infection from the inside – through the bloodstream.

In severe cases, surgery may be required. This is important if the bacteria have formed a pocket or abscess deep in tissue. The pocket protects the bacteria from applied treatments and the only solution is to open the area up surgically to remove the dead and infected tissue.