Trench mouth
Encyclopedia
Acute necrotizing ulcerative gingivitis (ANUG) or necrotizing ulcerative gingivitis (NUG) is a sub-classification of necrotizing periodontal disease, an infection
of the gum tissue
. This presents as an acute
infection of the gingiva
without involvement of the other tissues of the periodontium
. If the infection has progressed deeper into the periodontal tissues
, it is subclassified as "necrotizing ulcerative periodontitis" (NUP).
The condition is also commonly referred to as "trench mouth" and "Vincent's angina", named after French physician Henri Vincent (1862–1950). Other synonyms include "acute membranous gingivitis", "fusospirillary gingivitis", " fusospirillosis", "fusospirochetal gingivitis", "necrotizing gingivitis", "phagedenic gingivitis", "ulcerative gingivitis", "Vincent stomatitis", "Vincent gingivitis", and "Vincent infection".
and Fusobacterium
as well as spirochetes, such as Borrelia
and Treponema
.
In the late 1980s-early 1990s, it was originally thought that necrotizing periodontal diseases were strictly a sequela
of HIV
, and it was even called HIV-associated periodontitis. It is now understood that its association with HIV/AIDS
was due to the immunocompromised status of such patients, and it occurs with higher prevalence
in association with other diseases in which the immune system
is compromised.
Coincident factors may include heavy smoking
and poor nutrition
, especially for those presenting with necrotizing ulcerative periodontitis.
of necrotic areas (areas of dead and/or dying gum tissue), oral hygiene
instruction and the uses of mouth rinse
s and pain medication. As these diseases are often associated with systemic medical issues, proper management of the systemic disorders is appropriate.
and can spread, as necrotizing
stomatitis
or noma
, into neighbouring tissues in the cheeks, lips or the bones of the jaw. As stated, the condition can occur and be especially dangerous in people with weakened immune system
s. This progression to noma is possible in malnourished susceptible individuals, with severe disfigurement possible.
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
of the gum tissue
Gingiva
The gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...
. This presents as an acute
Acute
Acute may refer to:* Acute accent* Acute angle* Acute * Acute * Acute toxicity...
infection of the gingiva
Gingiva
The gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...
without involvement of the other tissues of the periodontium
Periodontium
Periodontium refers to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms peri-, meaning "around" and -odons, meaning "tooth." Literally taken, it means that which is "around the tooth"...
. If the infection has progressed deeper into the periodontal tissues
Periodontium
Periodontium refers to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms peri-, meaning "around" and -odons, meaning "tooth." Literally taken, it means that which is "around the tooth"...
, it is subclassified as "necrotizing ulcerative periodontitis" (NUP).
The condition is also commonly referred to as "trench mouth" and "Vincent's angina", named after French physician Henri Vincent (1862–1950). Other synonyms include "acute membranous gingivitis", "fusospirillary gingivitis", " fusospirillosis", "fusospirochetal gingivitis", "necrotizing gingivitis", "phagedenic gingivitis", "ulcerative gingivitis", "Vincent stomatitis", "Vincent gingivitis", and "Vincent infection".
Etiology
Necrotizing periodontal disease is caused by a bacterial infection that includes anaerobes such as P. intermediaPrevotella intermedia
Prevotella intermedia is a gram-negative obligate anaerobic pathogen involved in periodontal infections, including gingivitis and periodontitis, and often found in Acute necrotizing ulcerative gingivitis . It is commonly isolated from Dentoalveolar abscesses, where obligate anaerobes...
and Fusobacterium
Fusobacterium
Fusobacterium is a genus of filamentous, anaerobic, Gram-negative bacteria, similar to Bacteroides.Fusobacterium contribute to several human diseases, including periodontal diseases, Lemierre's syndrome, and topical skin ulcers...
as well as spirochetes, such as Borrelia
Borrelia
Borrelia is a genus of bacteria of the spirochete phylum. It causes borreliosis, a zoonotic, vector-borne disease transmitted primarily by ticks and some by lice, depending on the species...
and Treponema
Treponema
Treponema is a bacterial genus. The major species is Treponema pallidum, whose subspecies are responsible for diseases such as syphilis and yaws.The species Treponema hyodysenteriae and Treponema innocens have been reclassified into Serpula....
.
In the late 1980s-early 1990s, it was originally thought that necrotizing periodontal diseases were strictly a sequela
Sequela
A sequela) is a pathological condition resulting from a disease, injury, or other trauma.Chronic kidney disease, for example, is sometimes a sequela of diabetes, and neck pain is a common sequela of whiplash or other trauma to the cervical vertebrae. Post-traumatic stress disorder may be a...
of HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, and it was even called HIV-associated periodontitis. It is now understood that its association with HIV/AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
was due to the immunocompromised status of such patients, and it occurs with higher prevalence
Prevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
in association with other diseases in which the immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
is compromised.
Signs and symptoms
Clinical features of necrotizing periodontal disease may include:- necrosisNecrosisNecrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
and/or punched outulcerationMouth ulcerA mouth or oral ulcer is an open sore in the mouth, or rarely a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. The types of mouth ulcers are diverse, with a multitude of associated causes including: physical abrasion, acidic fruit, infection, other medical...
of the interdental papillaInterdental papillaThe interdental papilla, also known as the gingival papilla, is the part of the gingiva that exists coronal to the free gingival margin on the buccal and lingual surfaces of the teeth....
e ("punched-out papillae") or gingival margin - pseudomembranous formation
- painful, bright red marginal gingiva that bleed upon gentle manipulation
- halitosisHalitosisHalitosis is a term used to describe noticeably unpleasant odors exhaled in breathing. Halitosis is estimated to be the third most frequent reason for seeking dental aid, following tooth decay and periodontal disease.- General :...
Coincident factors may include heavy smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
and poor nutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, especially for those presenting with necrotizing ulcerative periodontitis.
Treatment
Treatment includes irrigation and debridementDebridement
Debridement is the medical removal of a patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue...
of necrotic areas (areas of dead and/or dying gum tissue), oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
instruction and the uses of mouth rinse
Mouthwash
Mouthwash or mouth rinse is a product used to enhance oral hygiene. Some manufacturers of mouthwash claim that antiseptic and anti-plaque mouth rinse kill the bacterial plaque causing cavities, gingivitis, and bad breath. Anti-cavity mouth rinse uses fluoride to protect against tooth decay...
s and pain medication. As these diseases are often associated with systemic medical issues, proper management of the systemic disorders is appropriate.
Prognosis
Untreated, the infection may lead to rapid destruction of the periodontiumPeriodontium
Periodontium refers to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms peri-, meaning "around" and -odons, meaning "tooth." Literally taken, it means that which is "around the tooth"...
and can spread, as necrotizing
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
stomatitis
Stomatitis
Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth...
or noma
Noma (disease)
Noma also known as cancrum oris or gangrenous stomatitis, is a gangrenous disease leading to tissue destruction of the face, especially the mouth and cheek.-Causes:...
, into neighbouring tissues in the cheeks, lips or the bones of the jaw. As stated, the condition can occur and be especially dangerous in people with weakened immune system
Immunodeficiency
Immunodeficiency is a state in which the immune system's ability to fight infectious disease is compromised or entirely absent. Immunodeficiency may also decrease cancer immunosurveillance. Most cases of immunodeficiency are acquired but some people are born with defects in their immune system,...
s. This progression to noma is possible in malnourished susceptible individuals, with severe disfigurement possible.
Notable people affected
- author William StyronWilliam StyronWilliam Clark Styron, Jr. was an American novelist and essayist who won major literary awards for his work.For much of his career, Styron was best known for his novels, which included...
- football player Ernie DavisErnie DavisErnest "Ernie" Davis was an American football running back and the first African-American athlete to win the Heisman Trophy. Wearing number 44, Davis competed collegiately for Syracuse University before being drafted by the Washington Redskins, then almost immediately traded to the Cleveland...
- actress Marilyn MonroeMarilyn MonroeMarilyn Monroe was an American actress, singer, model and showgirl who became a major sex symbol, starring in a number of commercially successful motion pictures during the 1950s....
- artist Robert MapplethorpeRobert MapplethorpeRobert Mapplethorpe was an American photographer, known for his large-scale, highly stylized black and white portraits, photos of flowers and nude men...
- paratrooper and author Donald BurgettDonald BurgettDonald R. Burgett is a writer and a former World War II paratrooper. He was among the Airborne troopers who landed in Normandy early on the morning of D-Day. He was a member of the 101st Airborne Division, , and the 506th Parachute Infantry Regiment...
See also
- Angina bullosa haemorrhagicaAngina bullosa haemorrhagicaAngina bullosa haemorrhagica is a condition of the mucous membranes characterized by the sudden appearance of one or more blood blisters within the oral cavity....
- Trench footTrench footTrench foot is a medical condition caused by prolonged exposure of the feet to damp, unsanitary, and cold conditions. It is one of many immersion foot syndromes...
- Riggs' diseaseRiggs' diseaseRiggs' disease, also known as pyorrhea of a toothsocket or gingivitis expulsiva, is a purulent inflammation of the dental periosteum named after American dentist John W. Riggs ....
- List of cutaneous conditions