Acute necrotizing ulcerative gingivitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 27, 2016
StartDiseasesAcute necrotizing ulcerative gingivitis

Trench mouth disease, also known as acute necrotizing ulcerative gingivitis (ANUG) or simply necrotizing ulcerative gingivitis, is a severe infection of the gum, occurring most commonly in younger adults and teenagers. This infection is characterized by painful gums and bleeding gums, accompanied by ulcers inside the mouth. Trench mouth infection is also known as Vincent’s stomatitis, Vincent disease, and Vincent angina.


Definition & Facts

Mouths naturally contain a balanced quantity of healthy bacteria, but poor oral hygiene can lead to an increase of bacteria. Trench mouth infections are caused by a harmful accumulation of bacteria in the mouth such as Prevotella intermedia and spirochaetes. The symptoms that ensue with this kind of gingivitis as with all types of gingivitis are red, sensitive, and bleeding gums.

Trench mouth is a form of rapidly progressing gingivitis. The term “trench mouth” can be traced back to the First World War, in which soldiers often experienced severe gum issues as a result of lacking access to adequate dental care while in battle. Although trench mouth is a serious condition, it is rare in industrialized countries and usually affects underdeveloped nations and localities with poor nutritional and living standards or conditions. It most commonly affects people between the ages of 15 and 35 according to the National Institute of Health.

Trench mouth disease is a type of necrotizing periodontal disease. This group of conditions involves the necrosis or cell death of the gums, the periodontal fibers which attach the tooth to the bone, and the alveolar process, which is the bone that contains the sockets into which the teeth fit.

Symptoms & Complaints

Even though the symptoms of trench mouth are quite similar to those of gingivitis, these symptoms tend to progress at a more rapid rate. The symptoms of trench mouth include:


The cause of acute necrotizing ulcerative gingivitis is bacterial infection resulting from the accumulation and eventual overabundance of harmful bacteria inside the mouth. If an individual already has gingivitis, they are at risk of developing trench mouth, which is an advanced form of the condition. Trench mouth has additionally been associated with other risk factors; these include the following:

In the event that acute necrotizing ulcerative gingivitis is left untreated, the infection will typically worsen and causes damage to gum tissues, which can lead to a wide variety of additional problems to the patient. The possible complications include ulcers, dehydration, pain, loss of teeth, and the spread of infection.

Diagnosis & Tests

During a dental examination, the dentist may gently prod a patient’s gums to see how easily they bleed once poked. This can indicate gingivitis if not trench mouth specifically. A dentist or other health care provider will also visually examine a patient’s mouth for signs such as crater-like ulcers full of dental plaque and food debris, inflamed gums, swollen lymph nodes in the neck and head, the destruction of gum tissues around the teeth, and the existence of a gray film caused by decomposed gum tissue.

An individual's health care provider can also request an X-ray test to verify whether the infection has spread to the bones beneath the patient’s gums. A dental X-ray will help determine the severity of the infection as well as the quantity of gum tissue that has been destroyed as a result of the infection

A health care provider can additionally test for other symptoms, such as a high grade fever or fatigue, or perform a blood test, which involves drawing a patient’s blood in order to explore the possibility of undiagnosed conditions that may be contributing to the patient's oral infection. Alternatively, a throat swab culture may be requested to determine the nature of the infection.

Treatment & Therapy

The most important and primary aim of treatment is to cure the infection and relieve all symptoms, and a good oral hygiene plan plays an important part in the treatment of trench mouth. Proper treatment includes antibiotics to minimize and stop further spread of the infection and also to reduce discomfort, a professional teeth cleaning provided by an oral hygienist, over-the-counter pain relievers as well as continual and proper oral hygiene and care.

Thoroughly flossing and brushing of teeth at least twice a day makes for an important technique for controlling trench mouth symptoms. Some recommend brushing and flossing after every meal and at bedtime. A patient might require significant dental work including frequent dental examinations and cleanups until oral health is restored.

The pain that accompanies inflamed gums can be eased with the use of warm water combined with salt in measurements of 1/2 teaspoon of salt and a single cup of water. Coating agents or soothing rinses can also reduce pain, especially when used before meals, and for severe pain, lidocaine may offer relief. Hydrogen peroxide is strongly recommended as an oral rinse since it helps in the removal of dead or dying gum tissue.

Prevention & Prophylaxis

To prevent trench mouth disease, it is important to maintain regular and effective dental care. Although trench mouth is usually treatable, it is also highly preventable. To prevent acute necrotizing ulcerative gingivitis from occurring in the first place and to prevent complications related to trench mouth, individuals should take the following steps on a regular basis;

  • Avoid all tobacco products such as cigarettes. Quitting smoking is an absolute requirement for ensuring oral health as well as overall health.
  • Floss and brush teeth at least twice every day.
  • Maintain proper nutrition
  • Practice stress reduction techniques in order to reduce the risk of developing trench mouth associated with stress.
  • Avoid irritants, such as hot and spicy foods.
  • Make sure to attend regular and professional dental examinations and cleanings.