Trench Mouth and TEOTWAWKI

Our friendly tooth doctor was inspired to write this after the Buckeyes beat Michigan. 

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As I have been thinking about what a dentist can add to a discussion of health care after a serious disruption of civilization, it occurred to me that a likely candidate for a condition not commonly seen in today’s world would be that of Acute Necrotizing Ulcerative Gingivitis (ANUG). Trench mouth in layman’s terms. It is also known as Vincent’s Stomatitis.

This is a rare condition, almost unheard of in a normal, healthy, well-nourished individual living in a quiet environment. Take that same individual and place him or her in a survival environment and a certain number will develop ANUG. It is a product of a combination of normal oral flora, poor dental hygiene, bad diet, lack of sleep, and stress. During WWI soldiers on both sides of the conflict found themselves in cold, wet, drafty trenches, eating bully beef and stale bread, under constant bombardment, for weeks on end. Among the many health complaints that became manifest was this condition. Hence the name Trench mouth.

Know this condition by the following signs and symptoms: BAD breath (smell it across the room bad), Gum Pain (difficulty eating, brushing), Punched out gum tips between the teeth (Gingival Papilla). The patient may have malaise, slight fever, swollen neck nodes, but the tell is the first three symptoms.

I have seen this condition in freshman college students usually around early November, about two weeks after midterm grades. First time away from home,dorm food, all night sessions (some actually call it study), add to that the realization that they have to go home with their grades at the end of the semester. Who knew that college and combat had so many similarities?

The etiology of this condition is an overgrowth of normal oral flora, mostly anaerobic, and an altered immune response caused by stress and bad diet. The cause gives us the key to the cure: oxygen in the form of hydrogen peroxide (OTC cut in half with water) aggressive rinses several times each day; aggressive brushing as soon as the gums will tolerate it; 2 % Chlorohexadine (Peridex) dental rinse twice a day is also a big help; multi-vitamin with minerals each day; and as much R and R as possible. Antibiotics are possible, but we will probably want to save them for worse problems.

In my experience this is enough to overcome the acute symptoms in an otherwise healthy individual. There is a chronic form of this condition that we see, but the non-dentist treatment would be about the same.   

OK, one last thing – if you have all the symptoms listed above in a sickly patient, and you look at the gums and see any tooth roots or ulcerative extensions past the gums onto the oral mucosa…you could well be looking at an advanced AIDS patient. BE CAREFUL. In this patient, the symptomatic treatment is the same . . . just do not expect much recovery.

Copyright © 2010 WH2thdr

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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One Response to Trench Mouth and TEOTWAWKI

  1. TinGrin says:

    Good post! I ran into this condition on my first patient as a sophomore dental student and was that an eye opener! The only thing I can think to add to the wonderful job you have done is to say that I find that diluting the hydrogen peroxide 50/50 with Scope makes it a much more palatable experience for the patient.

    Keep up the great posts!

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