Mayo Clinic Health Library

Trench mouth

Updated: 04-09-2013

Definition

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.

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Symptoms

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.

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Causes

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.

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Risk factors

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.

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Complications

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
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Tests and diagnosis

Your dentist usually can diagnose trench mouth by examining your teeth and gums. Sometimes you may need dental X-rays to determine whether bone loss has occurred as a result of the infection.

If it's not known why you developed trench mouth, your dentist will refer you to your primary care doctor for additional exams or blood tests. This can help determine if you have any undiagnosed medical conditions, particularly HIV, that may have promoted your trench mouth.

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Treatments and drugs

Treatment of trench mouth is generally highly effective, and complete healing often occurs in just a couple of weeks. However, healing may take longer if your immune system is weakened, such as by HIV/AIDS.

Medications
Medication for trench mouth treatment may include:

  • Antibiotics. Because trench mouth involves an overgrowth of bacteria, antibiotics are often prescribed to get rid of the bacteria and prevent infection from spreading.
  • Pain relievers. You may also need an over-the-counter or prescription pain reliever. Getting pain under control is important so you can eat properly and resume good dental care habits, such as brushing your teeth and flossing. Your dentist may also recommend a pain reliever that you can apply directly to your gums (topical anesthetic).
  • Antiseptic mouth wash. Prescription antiseptic mouthwash containing chlorhexidine can decrease the bacterial count, speeding recovery.

Cleaning your teeth and gums
Treatment also includes a thorough but gentle cleaning of your teeth and gums. Your mouth may be rinsed with an antiseptic solution. When your gums are less tender, you'll have a type of tooth cleaning called scaling and root planing. This procedure removes plaque and tartar from beneath your gumline and smooths any roughened surfaces of your teeth that catch bacteria.

Right after cleaning, your gums will be quite tender. Your dentist will probably advise you to rinse your mouth with a hydrogen peroxide mouthwash, salt water or a prescription mouth rinse, in addition to brushing gently with a soft toothbrush. Once your gums begin to heal, brush and floss at least twice a day — preferably after every meal and at bedtime — to prevent future problems.

When surgery is necessary
Although your gums are likely to heal and return to their normal shape with professional cleaning and proper home care, you may need surgery to help repair them if you have extensive damage.

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Lifestyle and home remedies

Trench mouth can be extremely painful. To help care for yourself and cope during treatment:

  • Avoid smoking or using other tobacco products
  • Take pain medications as recommended
  • Follow a liquid diet, if recommended, the first few days of treatment to minimize pain
  • Avoid spicy or very hot foods, which can irritate your tender gums
  • Drink plenty of water to stay hydrated
  • Avoid drinking carbonated beverages or alcohol
  • Keep all dental appointments
  • Get plenty of rest to reduce physical and emotional stress
  • Eat a healthy diet to improve nutrition
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Prevention

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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