Acute Necrotizing Ulcerative Gingivitis

Also Know As Trench Mouth, Vincents Infection, Vincents Disease, Fusospirochetosis

Acute Necrotizing Ulcerative Gingivitis

Acute necrotizing ulcerative gingivitis (also known as trench mouth, due to its prevalence among soldiers in WWI) is a non-contagious, painful infection of the gums.

Causes

The overgrowth of bacteria and subsequent infection of the gums is often caused by:

·         Poor oral hygiene;

·         Physical and/or emotional stress;

·         Sleep deprivation;

·         Nutritionally-inadequate diet;

·         Smoking; and

·         Pre-existing gingivitis.

Disease pathway

The symptoms of trench mouth all stem from an infection of the gums, due to the presence of excessive bacteria in the mouth.

Symptoms and diagnosis

The onset of symptoms associated with trench mouth is quite rapid. These include:

·         Painful gums;

·         Erosion and necrosis of the gum;

·         Extremely foul breath;

·         Susceptibility to bleeding from the gums; and

·         Difficulty in eating and swallowing.

Diagnosis can generally be made based on the distinctively foul smell of the breath, in conjunction with physical examination.

Treatment

A thorough, professional cleaning, followed by rinsing the mouth with hydrogen peroxide solution several times daily is the usual method of treatment. Antibiotics may also be administered, to treat the infection.

Brushing the patient’s teeth is avoided, as the gums are highly sensitive to abrasion.

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Tea Tree Oil [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present. WARNING: Tea Tree Oil is not recommended for children, pregnant women or mothers that are breastfeeding.

Recommendation: No recommendation (There is insufficient evidence to support claims that tea tree oil is effective in treating gingivitis)

Grade of Evidence: low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/tea-tree-oil

3. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-teatreeoil.html

4. http://www.ncbi.nlm.nih.gov/pubmed/18816275

5. http://bastyrcenter.org/content/view/972/&page=

6. http://jac.oxfordjournals.org/cgi/content/full/62/4/769?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=staphaseptic&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

7. http://www.ncbi.nlm.nih.gov/pubmed/2145499

8. http://www.ncbi.nlm.nih.gov/pubmed/9055360

9. http://www.ncbi.nlm.nih.gov/pubmed/12451368

10. http://www.ncbi.nlm.nih.gov/pubmed/9848442

11. Bishop, C.D. (1995). "Anti-viral Activity of the Essential Oil of Melaleuca alternifolia". Journal of Essential Oil Research: 641–644

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