Necrotizing ulcerative gingivitis
(Vincent’s infection, trench mouth)
DESCRIPTION: This is a specific type of infection of oral mucosa whose lesions are found chiefly on marginal gingiva. Necrosis of the interdental papillae that spreads to involve adjacent facial and lingual surfaces is virtually diagnostic. The ulcerated gingiva is covered by creamy exudates. Patients have pain and halitosis and in severe cases, fever and cervical lymphadenitis. Spread of lesions into the throat has been referred to as Vincent’s angina. The disease occurs in all age groups but is uncommon in children.
ETIOLOGY: Treponema, Selenomonas, and Prevotella species have been identified in the lesions. They are suspected of being the chief etiologic agents although reinoculation of these organisms into tissues of volunteers has not reproduced the disease. Reduction of patient resistance is thought to play an etiologic role.
TREATMENT: Treatment consists of debridment and cleaning the teeth plus a broad spectrum antibiotic in those with fever and cervical lymphadenitis. Topical anesthetics may provide palliation.
PROGNOSIS: Good
DIFFERENTIAL DIAGNOSIS: Agranulocytosis
