MOUTH & TEETH Mouth & Gum • Bad breath • Canker sore • Gingivitis • Periodontitis • Oral thrush • Trench mouth • Leukoplakia • Burning mouth syndrome • Oral lichen planus • Geographic tongue

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Trench mouth earned its name because of its prevalence among soldiers who were stuck in the trenches during World War I without the means to take care of their teeth properly. As a result, they often developed trench mouth, a severe form of gingivitis that causes painful, infected, bleeding gums and ulcerations.

Although trench mouth is rare today in developed nations, it still occurs, most often in people younger than age 35. Trench mouth occurs much more commonly in developing nations with poor nutrition and poor living conditions. Trench mouth is also known as Vincent's stomatitis and acute necrotizing ulcerative gingivitis (ANUG).

Without treatment, trench mouth continues to worsen, and it may lead to other conditions that can cause serious infection that can spread to other areas of your body. Fortunately, regular brushing and flossing, professional tooth cleaning and antibiotics can usually clear up the infection from trench mouth. And practicing good oral hygiene can help prevent future problems.

Signs and symptoms of trench mouth can develop rapidly. They include:

• Painful gums
• Bleeding from gums with the slightest pressure
• Red or swollen gums
• Pain when eating or swallowing
• A gray film on your gums
• Crater-like sores (ulcers) between your teeth and on your gums
• A foul taste in your mouth
• Bad breath
• Fever
• Swollen lymph nodes around your head, neck or jaw

Your mouth is naturally teeming with microorganisms, including fungi, viruses and bacteria. Although this might sound unpleasant, most of these microorganisms are actually beneficial because they help break down food and protect you from disease-causing organisms.

In trench mouth, though, harmful bacteria are able to grow out of control. This overgrowth causes infection of your gums. This infection can damage or destroy the delicate gum tissue (gingiva) that surrounds and supports your teeth. Large ulcers, often filled with bacteria, food debris and decaying tissue, may form on your gums, leading to severe pain, bad breath and a foul taste in your mouth.

Precisely how these bacteria destroy gum tissue isn't known. But it's thought that enzymes and toxins produced by the bacteria play a role.

Several factors can increase your risk of developing trench mouth by allowing harmful bacteria to grow out of control.

Risk factors include:

• Poor oral hygiene. Failing to brush and floss regularly can lead to a buildup of plaque and debris that help harmful bacteria thrive.
• Poor nutrition. Not getting enough nutrients can make it difficult for your body to fight infection. Malnourished children in developing countries are particularly at risk.
• Smoking or chewing tobacco. These can harm the blood vessels of your gums, making it easier for bacteria to thrive.
• Throat, tooth or mouth infections. If you already have an active infection, such as gingivitis, and don't treat it effectively, the infection can progress into trench mouth.
• Emotional stress. Emotional stress can weaken your immune system, making it difficult for your body's natural defenses to keep harmful bacteria in check.
• A compromised immune system. People with illnesses that compromise the immune system or who are undergoing treatment that can suppress the immune system are at higher risk because their bodies may not be able to fight infections well. These may include people with HIV/AIDS and cancer, for instance.

See your dentist immediately if you suddenly develop mouth pain, swollen or bleeding gums, or unusually bad breath. Often, these may be symptoms of a gum problem other than trench mouth, such as gingivitis or periodontitis. But all forms of gum disease can be serious and most tend to get progressively worse without treatment. The sooner you seek care, the better your chance of returning your gums to a healthy state and preventing loss of teeth and the destruction of bone or other tissue.

Diagnosing trench mouth isn't complicated. Your dentist can usually detect the disease simply by examining your teeth and gums. Sometimes you may need dental X-rays or facial X-rays to determine the extent of the infection and tissue damage. You may need blood tests if your dentist or doctor thinks infection may have spread to other areas of your body.

Trench mouth can be so painful that you have trouble eating or swallowing. The pain may also prevent you from properly brushing your teeth, which, in turn, can make the condition worse. Trench mouth also damages or destroys gum tissue.

If trench mouth isn't treated, or treatment is delayed, it can progress into other conditions in which infection can spread beyond the gums. When this happens, the infection can destroy tissue in your cheeks, lips and jawbone, which could cause you to lose some of your teeth. The infection can also enter your bloodstream, spreading throughout your body. In some people, especially those with compromised immune systems, trench mouth can progress into a condition called necrotizing stomatitis. Unless it's treated promptly, necrotizing stomatitis can severely damage bone and gum tissue, or worse, result in death. This is rare in developing nations but more common in countries where poor nutrition and poor dental hygiene are endemic.

Treatment of trench mouth is generally highly effective, and complete healing often occurs in just a couple of weeks. However, healing may take longer if your immune system is compromised, such as in HIV/AIDS.

Medications
Because trench mouth involves an overgrowth of bacteria, antibiotics are often prescribed to eradicate the bacteria and prevent infection from spreading. You may also need over-the-counter or prescription pain relievers. Getting pain under control is important so that you can eat properly and resume good dental care habits, such as brushing your teeth. Your dentist may also recommend a pain reliever that you can apply directly to your gums (topical anesthetic).

Cleaning your teeth and gums
Treatment also includes a thorough but gentle cleaning of your teeth and gums. Your dentist removes any dead gum tissue (debridement) to help reduce pain. Your mouth may be rinsed with an antiseptic solution. When your gums are less tender, you're likely to have a type of tooth cleaning called scaling and root planing. This procedure removes plaque and tartar from beneath your gumline and smooths any roughened surfaces of your teeth.

Right after cleaning, your gums will be quite tender. Your dentist will probably advise you to rinse your mouth with a hydrogen peroxide mouthwash, salt water or a prescription mouth rinse, in addition to brushing gently with a soft toothbrush. Once your gums begin to heal, brush and floss at least twice a day — preferably after every meal and at bedtime — to prevent future problems.

When surgery is necessary
Although your gums are likely to heal and return to their normal shape with professional cleaning and proper home care, you may need surgery to help repair them if you have extensive damage.

Good oral health, good nutrition and good overall health habits can help reduce your risk of developing trench mouth.

In particular:

• Practice good oral hygiene. Brush and floss your teeth at least twice a day or as often as your dentist recommends. Get regular professional dental cleanings. Antiseptic mouthwashes also may be helpful. Some studies show that an electric toothbrush may be more effective than a manual toothbrush.
• Don't smoke or use other tobacco products. Tobacco products are a leading factor in the development of trench mouth.
• Eat a healthy diet. Include plenty of fruits and vegetables, whole grains, lean meats and low-fat dairy foods.
• Manage stress. Because stress takes both a physical and an emotional toll, learning to manage it is essential for your overall well-being. Exercise, relaxation techniques, hobbies and yoga are among the healthy ways to cope with stress.

Trench mouth can be an extremely painful condition. You can take measures to help care for yourself and cope during treatment, such as:

• Taking pain medications as recommended
• Following a liquid diet the first few days of treatment to minimize pain, if necessary
• Avoiding spicy or very hot foods, which can irritate your tender gums
• Staying well hydrated
• Not drinking carbonated beverages or alcohol
• Keeping all dental appointments