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- Inflammatory infection of the gingiva, characterized by pain, ulcerations, and necrotizing damage to interdental papillae
- Caused by an imbalance of oral flora, resulting in a predominance of invasive anaerobic bacteria, such as Fusobacterium, Prevotella intermedia, and spirochetes
- Concomitant infection with Epstein-Barr virus, herpes simplex virus, and type 1 human cytomegalovirus is common.
- Organisms invade gingiva and interdental papillae and form a gray pseudomembranous exudate.
- Clinical presentation includes pain, fetid breath, gingival ulcerations, bleeding, and interdental papillary necrosis. It is differentiated from other periodontal diseases by rapid onset, pain, ulcerated gingival mucosa, and “punched out” interdental papillary necrosis.
- Synonym(s): Vincent angina; trench mouth; acute necrotizing ulcerative gingivitis (ANUG)
- Predominant age: 18 to 30 years in developed countries
- Malnourished children ages 3 to 14 years
- Affects both genders with similar frequency
- Prevalence is low in healthy children up to age 18 years.
- Prevalence is more common in persons aged 18 to 30 years. Prevalence increases with malnutrition, immunocompromised, poor oral hygiene, and smoking, or those from underdeveloped countries.
Etiology and Pathophysiology
- Impaired host immunologic response due to immunocompromised or malnutrition
- Disruption of normal oral flora with predominance of invasive anaerobic bacteria
- Loss of integrity and necrosis of the gingival mucosa and interdental papillae
- Increased bacterial attachment with active herpesvirus infection
- Immunosuppression (cancer, HIV infection)
- Tobacco use
- Poor oral hygiene
- Infrequent or absent dental care
- Herpesvirus infection
- Psychological stress
- Appropriate nutrition
- Proper oral hygiene
- Regular dental care
- Prompt recognition and institution of therapy
- Management of medical problems such as cancer and HIV infection
- Stress management
Commonly Associated Conditions
- Seen most commonly in malnourished patients, patients undergoing cancer treatment, or those from underdeveloped countries
- HIV infection
- Vitamin deficiencies
- Tooth loss
- Noma (cancrum) oris, which can be life-threatening
- Aspiration pneumonia