What are Causes of Trench Mouth?
Trench mouth, or necrotizing ulcerative gingivitis, is a bacterial infection of the gums, or gingiva. Like other infections, it is caused by bacteria which have penetrated into the tissues and are growing. Exactly how this happens isn’t completely understood (especially the contribution of viruses, if any) but some of the risk factors are.
The primary cause of trench mouth is poor oral hygiene. Healthy gums are pink, firm and tightly bound to the underlying bone or teeth. Without care, the gums become swollen, red, painful and bleed easily – all of this makes it easier for bacteria to get a foothold and develop into full-blown ulcerative gingivitis.
Trench mouth is primarily a disease of the poor. It is much more common in developing countries where proper nutrition is unavailable and dental hygiene practices are not up to par. However, even in industrialized nations, segments of the population will be at risk for the same reasons.
For example, in the addicted community, oral hygiene is often overlooked in pursuit of the addiction. Some addictions are even known for leading to nutritional deficiencies, primarily alcohol and amphetamines. The result is that even when a healthy diet is available, addicts may forgo it in favor of the addiction. Some drugs affect the mouth directly and can contribute to the likelihood of trench mouth – particularly methamphetamine and crack, both of which have a direct vasoconstriction action, limiting blood flow to the gums and increasing the risk of infections.
Smoking is also associated with an increased incidence of gingivitis, and this is a direct precursor to trench mouth. The nicotine also constricts blood vessels while the act of smoking tends to dry out the mouth.
Medical Problems Contributing to Trench Mouth
Any disease or treatment that suppresses the immune system can be a cause of trench mouth, especially when combined with poor oral hygiene. Some of these medical issues include:
- Transplant patients who receive immunosuppressant drugs to prevent organ rejection.
- Some types of cancers that directly affect the immune system.
- Some chemotherapy agents that suppress the immune system as a side effect of treatment.
- HIV, a virus that attacks the immune system and lowers the ability to prevent infection.
- Stress, which has been shown to lessen the immune response.
Trench mouth is also more common in those between 15 and 36 years of age, although age isn’t considered a direct risk factor or cause.
Direct Causes of Trench Mouth
The infectious agents are bacteria. These can be the normal bacteria that inhabit the mouth. When these bacteria gain access beneath the surface of the gums, they can quickly cause damage and kill living tissue. If there is an existing infection, for example in a tooth, this can provide a pathway into the gums. Commonly, food particles can build up in crevices or where gums are loose (do not make a tight seal to teeth). This “pocket” keeps saliva and other bacteria fighting mechanisms at bay. The pocket isn’t reachable by the bloodstream or the immune system either.
There is no one kind of bacteria that cause trench mouth. The oral cavity is home to more than 500 different types of bacteria, and an estimated 415 of those have been found in sub-gingival plaques. Scientists are still researching the flora of the mouth to identify which (if any) species cause the most trouble.
It is unlikely that we will ever develop an anti-bacterial solution that completely frees us from the risk of gingival infections. There are simply too many bacteria and the environment (warm, dark, moist) is too appealing. The only solution is prevention. Addressing the causes with good nutrition, proper oral hygiene and stress reduction will prevent almost all cases.