What Is Trench Mouth?

Trench mouth is a more severe version of gingivitis, it is highly treatable but severe cases may need further medical intervention.

Overview

The human body is colonised by bacteria, protozoa, fungi, and viruses; this is called a microbiome. They live on the skin and inside the body, helping to maintain the environment, aid with the digestion of food and even fight off more harmful bacteria. If the balance is not maintained, these bacteria can cause infection in adults and children. The term trench mouth comes from World War I as it was a common infection seen in soldiers, especially those in the trenches, due to poor diet and poor conditions.¹ Trench mouth is a more serious version of gingivitis, and it can lead to significant damage to the teeth and tissue. Trench mouth can go by many names:

• Gum disease
• Gingivitis 
• Vincent’s disease
• Vincent’s stomatitis 
• Fusospirochetal gingivitis 
• Acute Ulcerative gingivitis 
• Necrotising gingivitis 
• Necrotising ulcerative periodontitis 

Causes of trench mouth

Lots of factors can affect and upset the normal flora of the body such as medication, diet, and poor hygiene. Trench mouth is an infection of the gums, usually associated with poor oral hygiene and plaque formation. The normal flora of the mouth includes bacteria such as Streptococcus and Bacteroides, which first colonize the mouth during or after birth and breastfeeding.² When teeth emerge from the gum, it allows plaque formation and a hard surface for the bacteria to live on. Plaque builds up on your teeth over time, especially after eating high-sugar and starch food sources such as carbohydrates. Bacteria in the plaque use these food types as their energy source. 

Due to the availability of oral hygiene products like toothbrushes and fluoride toothpaste, gum disease is not often seen in the developed world. However, for those that do suffer with trench mouth, it is usually due to limited dental care, increased stress, or weakened immune systems. Trench mouth is often associated with anxiety and stress, such as with teenagers during exam periods. Usually, these cases have pre-existing gum disease or with those that have not maintained good oral health. Tobacco products have also been considered as a cause of trench mouth; smoking dries out the mouth, changing the environment for the bacteria that reside in the mouth. This change can make other, more harmful bacteria thrive. Smoking also weakens your immune system, which can lead to slower healing if an injury has occurred.

Signs and symptoms of trench mouth

Common symptoms of trench mouth include inflammation (swelling) of the gums and soft tissue, development of ulcers and lesions, bleeding of the gums and pain. 

The bleeding can occur with teeth brushing and flossing, but in severe cases, bleeding can happen when eating foods that are hard, such as apples and crusty bread. Mouth ulcer formation is usually a good indicator for trench mouth; they are painful sores or swellings in the mouth. In many cases, they can contain pus and food. In extreme cases, rotting of the flesh can occur; this is known as necrosis. Other symptoms of gum disease are bad breath (halitosis), shrinking gums and losing teeth. 

• Bad breath
• Bad taste in the mouth
• Redness 
• Slimy teeth
• Ulcers and lesions
• Fever (from infection)
• Bleeding
• Pain
• Fever 

Management and treatment for trench mouth

In many cases, trench mouth is both treatable and preventable. Early-stage trench mouth can be easily managed with improved oral hygiene; you may be advised by your dentist to see a hygienist. They may clean your teeth and show you how to brush better and maintain your oral hygiene. There are many over-the-counter and everyday products to manage oral hygiene and pain; these include paracetamol, antiseptic mouthwash, floss, toothpaste, and toothbrushes. You could also improve your oral hygiene by improving your diet and by quitting smoking.

In later stages of trench mouth the dentist will treat any infections with antibiotics, perform deep tissue cleaning and possibly remove affected teeth. With severe symptoms of trench mouth, where gangrene or necrosis has occurred, surgery may be required. Gingivectomies are surgeries that remove the gum tissue, and gingivoplasties are surgeries that reshape the gum around your teeth and are associated with necrotizing ulcerative gingivitis.³ If trench mouth is ignored or not effectively treated the infection can spread to and destroy your lips, cheeks and jaw. The spread of infection may lead to bacteria entering the bloodstream or brain, causing life-threatening sepsis (septicaemia) or meningitis.

Trench mouth will not go away if you do not receive treatment and sometimes treatment can fail. You are more at risk of gum diseases the older you get, especially if you have other conditions such as diabetes, AIDs, HIV or cancer. If there is a family history of gum disease, you should take increased steps to maintain your oral health. 

Complications of trench mouth

• Tooth Loss
• Gum loss
• Gangrene 
• Infection of surrounding tissue and bone
• Spread of infection to the bloodstream 
• Spread of infection to the brain 
• Cardiovascular and lung infections

Diagnosis of trench mouth

To fully see the extent of the disease and damage, your dentist may X-ray your mouth.

The dentist will usually begin by observing symptoms such as bad breath, craters/ulcers between your teeth, redness and swelling of the gums and surrounding tissues, any biofilms or plaque that have built up on your teeth, and bleeding after applying pressure.

Your doctor may check for general symptoms such as fever, fatigue, and other signs of infection. They will ask about your diet and overall health, your medical and familial history, to see if there are any factors that would make you susceptible to gum disease. You may receive a physical examination where they will feel your lymph nodes for signs of a deeper infection.

You may be swabbed in the mouth so that a sample can be sent to the hospital, where it will be cultured and examined for any harmful pathogens. You may also be sent for further tests, such as blood tests, to monitor the spread of an infection or possibly diagnose you with other conditions you may not know you have. 

Prevention of trench mouth 

Regular dental care is the best way to prevent trench mouth, especially if you are genetically predisposed to gum disease. Management of oral health is key in preventing trench mouth. you should brush regularly, the morning, evening, and after eating; this will prevent the build-up of plaque. Electric brushes and manual toothbrushes are available in most supermarkets and stores. 

Avoid stress and monitor your children's oral hygiene during stressful exam times. Reducing and avoiding certain high-sugar and starchy food products will reduce your risk of developing trench mouth. Also avoid cigarettes, tobacco and chewing tobacco as they dry out your mouth, creating the perfect breeding environment for pathogens. Smoking also lowers your immune system.

FAQs

How can I prevent trench mouth?

Improve your oral hygiene by brushing regularly, flossing in between your teeth and using antiseptic mouthwash. 

Improve your overall health and wellbeing by reducing your stress, stopping smoking, improving your diet and exercising regularly. 

How common is trench mouth?

Most adults get gum disease at some point in their lives, trench mouth is more common in less developed countries due to the lack of access to healthcare. 

Who is at risk of trench mouth?

Those who have a family history of gum disease, underlying conditions or weakened immune systems are at most risk for developing trench mouth. 

When should I see a doctor?

Your dentist is best for identifying the early signs of trench mouth. However, seek medical attention if your symptoms get worse in between dental visits or you start to develop signs of sepsis or meningitis. 

Summary

We share our body with many microbes, but problems like gingivitis and trench mouth can occur if we do not manage our health and hygiene. Poor oral hygiene, stress, smoking and illnesses all contribute to the development of trench mouth. Symptoms of trench mouth include bleeding when brushing our teeth or eating, pain, ulcers, bad breath, increased buildup of plaque and even death of surrounding tissue. Trench mouth is easily treated with antibiotics and managed with simple lifestyle changes and good oral health. Serious cases may involve surgery and complications can include sepsis. You are at greater risks if you are immunosuppressed, stressed or genetically predisposed to gum diseases. Trench mouth is commonly seen in patients with diabetes, HIV and AIDs. A dental appointment will allow your dentist to diagnose trench mouth by observing your symptoms; further medical intervention may be required in more complicated cases. Seek medical advice if symptoms worsen between dental visits. To prevent trench mouth brush well, avoid too many carbohydrates and attend regular dental appointments.