Acute Necrotizing Ulcerative Gingivitis (ANUG) • Trench Mouth
What is ANUG • Trench Mouth
Acute Necrotizing Ulcerative Gingivitis is a severe and painful inflammation of the gums, which causes deep ulcerations of the gingival tissues. The condition is caused by poor oral hygiene combined with poor nutrition and weak immune system. If left untreated, the infection can lead to the necrosis of gum tissues and may spread to other areas of the body.
What is Acute Necrotizing Ulcerative Gingivitis?
Acute Necrotizing Ulcerative Gingivitis, also referred by its acronym ANUG, is known with several other terms such as ‘acute membranous gingivitis’, ‘fusospirochetal gingivitis’, or by the names Vincent’s stomatitis, Vincent’s angina, or Vincent’s infection after the French bacteriologist Jean Hyacinthe Vincent (1862-1950) who is credited with the discovery of the organisms that cause the disease.
Another common name for Acute Necrotizing Ulcerative Gingivitis is ‘trench mouth’ which comes from World War I, when many soldiers suffered from the disease as they were fighting in the trenches under extremely stressful conditions and without the means to take proper care of their teeth and gums.
Acute Necrotizing Ulcerative Gingivitis is a much more severe condition than normal gingivitis, which can finally lead the death of gum tissue. The infection may lead to rapid destruction of the periodontal tissues and can spread into nearby tissues such as the cheeks, lips or jawbone (developing into necrotizing stomatitis). It can also spread to the tonsils and pharynx.
Although it can lead to serious complications if left untreated, treatment of trench mouth disease is, in most cases, simple and effective. It is now rare in developed countries, affecting mostly people with a weakened immune system. ANUG occurs much more commonly in developing nations with poor nutrition and poor living conditions and no access to dental care. Acute Necrotizing Ulcerative Gingivitis is a no contagious infection.
What Causes Acute Necrotizing Ulcerative Gingivitis?
The main cause of Acute Necrotizing Ulcerative Gingivitis is the excessive growth of certain harmful bacteria in the mouth, resulting in severe infection of the gums.
A variety of micro-organisms normally exist harmlessly in the human mouth. External factors that disturb the balance between the various micro-organisms of the natural flora of the mouth, may allow some of the harmful bacteria to grow out of control. This overgrowth causes a painful infection of the gums, which can seriously damage or destroy the periodontal tissues that support the teeth (periodontal ligament and gums).
Several factors can increase the risk of developing trench mouth by disrupting the normal balance of bacteria in the mouth :
Other risk factors increasing the possibility of developing ANUG include:
What are the Symptoms of Acute Necrotizing Ulcerative Gingivitis?
The first symptoms of Acute Necrotizing Ulcerative Gingivitis are similar to those of common gum disease including:
The more serious symptoms of Acute Necrotizing Ulcerative Gingivitis may appear suddenly and develop rapidly:
How Is Acute Necrotizing Ulcerative Gingivitis Diagnosed?
Visit your dentist or a periodontist (a dentist specializing in the diagnosis and treatment of gum diseases) immediately if you notice any of the symptoms of Acute Necrotizing Ulcerative Gingivitis. Although the initial symptoms may look like that it is a common gingivitis, they should not be ignored especially by patients who belong at the high risk groups for developing ANUG. Even if the condition proves not to be trench mouth disease but another condition such as gingivitis or periodontitis, it is important to get treatment as soon as possible to prevent any damage to teeth or gums.
Acute Necrotizing Ulcerative Gingivitis can progress rapidly into serious mouth problems like loss of gum tissue and tooth loss.
Treatment of Acute Necrotizing Ulcerative Gingivitis
The main goals of the treatment of Acute Necrotizing Ulcerative Gingivitis are to stop the infection, relieve the symptoms and restore the damaged gum tissue using:
It is recommended that (at least during ANUG treatment) any cause of irritation to the gums, such as smoking, eating spicy foods and drinking alcohol should be avoided. Treatment of trench mouth with regular brushing and flossing, professional tooth cleaning and antibiotics is generally effective. In mild cases of Acute Necrotizing Ulcerative Gingivitis complete healing is expected in a couple of weeks.
However, if the underlying or pre-disposing conditions that led to ANUG are not eliminated, the condition may become chronic and start to affect the deeper structures becoming chronic necrotizing ulcerative periodontitis, which leads to both gum tissue and tooth supporting bone loss.
Prevention of Acute Necrotizing Ulcerative Gingivitis
Prevention of trench mouth disease is based on maintaining good oral health, good nutrition and good overall health habits.
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