“Trench Mouth”

Acute Necrotizing Ulcerative Gingivitis (ANUG), more commonly known as “trench mouth” for its common occurrence among soldiers in the trenches during World War I, is a painful gum disease caused by the gram negative bacteria known as spirochetes.

Trench mouth is commonly associated with stress and acute anxiety, which, for teens, can take place around exam times, but it can occur in anyone going through an acute period of stress — if the underlying conditions are right.

It is often associated with an underlying or pre-existing minor gingivitis in individuals who may have not been taking good care of their oral health, brushing, flossing and getting regular dental checkups and cleanings. ANUG is also commonly associated with smoking, which seems to dry the mouth and change the bacterial flora — the normal bacteria that reside in the mouth, and is even necessary for health.

Trench Mouth Symptoms:

  • Severe gum pain
  • Bleeding from gums when they’re pressed even slightly
  • 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 mouth
  • Bad breath
  • Fever
  • Swollen lymph nodes around your head, neck or jaw
Acute Necrotizing Ulcerative Gingivitis

Acute Necrotizing Ulcerative Gingivitis

Trench Mouth Disease Treatment (ANUG)

ANUG is very treatable and completely reversible if caught early. Most importantly, contact your dentist or a periodontist (a dentist specializing in the diagnosis and treatment of gum diseases), to confirm that this is indeed what you have. Although ANUG is quite easy to diagnose by a trained professional, there are other conditions that it could be confused with, which range from viral infection to localized malignancy (cancer).

Treatment is aimed first at relieving the symptoms and then the underlying or predisposing conditions that led to it. Non-steroidal anti-inflammatory and pain controlling medication of the aspirin and ibuprofen family are ideal for this situation, in addition to prescription antibiotics. Metronidazole is an antibiotic that works well to kill the specific bacteria associated with ANUG; amoxicillin is broad-spectrum penicillin that also works well in treating the acute phase. These are antibiotics that must be taken orally to work their way through the body. Taken together with chlorhexidine, a prescription antibacterial mouthrinse, and saline (mild saltwater) rinses, symptoms should abate within 24 to 48 hours.

It is also important to treat the underlying conditions that led to the ANUG in the first place. Good oral hygiene including training in brushing and flossing technique, together with treatment for any underlying chronic gingivitis, generally by thoroughly and meticulously removing stain, bacterial biofilm and calculus (tartar) from the teeth, will allow the gums to heal. In addition, if there is underlying periodontal disease this should also be treated. Quitting smoking, getting rest and maintaining good nutrition are also important.

If only the acute symptoms are relieved, or only the acute phase is treated, the condition can become chronic. The papillae (triangle of gum in between the teeth), which initially becomes ulcerated and necrotic, will not heal and will become permanently lost or blunted. Chronic necrotizing ulcerative gingivitis can affect the deeper structures becoming chronic necrotizing ulcerative periodontitis, particularly if there is a pre-existing periodontitis, with both gum tissue and tooth supporting bone loss.

Therefore, it is very important to see your dentist or periodontist immediately to have this treated before the condition becomes serious.