Trench mouth

Trench mouth is a severe form of gingivitis that causes painful, infected, bleeding gums and ulcerations. Although trench mouth is rare today in developed nations, it's common in developing countries that have poor nutrition and poor living conditions.

Trench mouth, also known as necrotizing ulcerative gingivitis (NUG), earned its nickname because of its prevalence among soldiers who were stuck in the trenches during World War I without the means to properly take care of their teeth. Trench mouth is not contagious.

Symptoms Causes Risk factors Complications Prevention

Signs and symptoms of trench mouth can include:

  • Severe gum pain
  • Bleeding from gums when they're pressed even slightly
  • Red or swollen gums
  • Pain when eating or swallowing
  • Gray film on your gums
  • Crater-like sores (ulcers) between your teeth and on your gums
  • Foul taste in your mouth
  • Bad breath
  • Fever and fatigue (malaise)
  • Swollen lymph nodes around your head, neck or jaw

When to see a dentist

Trench mouth symptoms can develop quickly. See your dentist immediately if you develop any symptoms. Often these may be symptoms of a gum problem other than trench mouth, such as another form of gingivitis or a gum infection called periodontitis.

All forms of gum disease can be serious, and most tend to get worse without treatment. The sooner you seek care, the better your chance of returning your gums to a healthy state and preventing permanent loss of teeth and destruction of bone or other tissue.

Your mouth naturally contains microorganisms, including fungi, viruses and bacteria. If your immune system, which fights infections, is weak, its ability to fight harmful bacteria is lowered. This can result in trench mouth, where harmful bacteria grow out of control, causing 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. Exactly how these bacteria destroy gum tissue isn't known, but it's likely 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, including:

  • 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 of trench mouth.
  • 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.
  • Compromised immune system. People with illnesses that weaken 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, cancer or mononucleosis.

Trench mouth can occur at any age, although it's rare today in developed nations, especially with the availability of antibiotics. In developing countries where malnutrition is common and sanitation and good oral hygiene are lacking, trench mouth is more prevalent.

Complications and problems that trench mouth may cause or be associated with include:

  • Trouble eating and swallowing due to pain
  • Pain when brushing teeth
  • Temporary or permanent destruction of gum tissue
  • Tooth loss due to severely damaged bone

Good 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, choose whole grains instead of refined grains, eat healthy protein such as fish or legumes, and opt for 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, yoga and hobbies are examples of healthy ways to cope with stress.
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