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Wednesday, May 22, 2013
Pyorrhea and trench mouth
What is the diference between pyria and trench mouth?
Both diseases are the “old” terminology used to describe two etiologically different diseases that affect the periodontium. Pyorrhea refers to the discharge of pus and descriptively reflects “fire of the gums” that is associated with pocketing and inflammation of the tissues surrounding the teeth. Pyorrhea was also referred to as “Rigg’s Disease”, but now is categorized as chronic periodontitis associated with varying degrees of pocketing, formation of pus around the teeth, and subsequent alveolar bone loss that ultimately results in tooth mobility and tooth loss. Trench Mouth or “Necrotizing Ulcerative Gingivitis" (NUG) is another disease that affects the tissue surrounding the teeth and has a specific and distinctive pattern of pathologic changes noted in the gingival tissues. Also know as Vincent’s Disease, it was named after the physician that in the 1890s identified the anaerobic bacteria responsible for the acute gingival ulceration and inflammation (Treponema sp. Fusobacterium sp., Borrelia vincente, Prevotella sp.). The term “trench mouth” was derived from the increased prevalence in persons fighting in the trenches during World War I. This disease was also prevalent in students during final examination periods and was the result of increased stress, lack of sleep, poor nutrition (cigarettes, coffee, coke, and more cigarettes).
It should be noted this disease can also be related to increased immune suppression, such as that seen in AIDS and/or infectious mononucleosis. Other factors that are associated with development of NUG include smoking, poor nutrition, trauma to the gingiva, recent systemic illness, and poor oral hygiene.Classic presentation of NUG is something a dental student (myself included) will never forget. The patient commonly presents with the chief complaint of severe pain around the gums. Touching the gingival tissues is excruciating, and usually results in bleeding. The gingival tissue looks “punched out and edematous, and has a grayish yellow pseudo membranous covering". The classic identifier, though, is the smell; these patients present with a horrible fetid odor that smells like they had something die in their mouth. (In actuality, that is what is occurring. The tissues around the teeth have become necrotic and necrotic gingival tissue accumulates). Most patients will have a low grade fever (99-100°F), have cervical lymphadenopathy (swollen lymph nodes of the neck), and feel tired and achy (flu-like symptoms). Treatment is simple, generalized debridement of the affected tissues and in some cases the use of oral antimicrobial rinses such as chlorhexadine or baking soda/hydrogen peroxide rinses are helpful in reducing the bacterial load and rinsing the inflamed tissues. Some cases necessitate systemic or topical antibiotics (metronidazole, tetrcycline doxycycline, penicillin, and/or erythromycin). These drugs are generally prescribed if fever and/or lymphadenopathy are present. Generally though the most efficacious treatment is improving oral hygiene, and having the patient get rest, nutrition, and hydration. In other words, supportive therapy and removal of the stressors.
Richard J Jurevic, DDS, PhD
Assistant Professor of Biological Sciences
School of Dental Medicine
Case Western Reserve University