Vincent’s disease

Introduction

Vincent’s disease is a severe ulcerating gingivitis. It has many acronyms, including trench mouth and acute ulcerative gingivitis. The infection occurs typically in those with poor oral hygiene but is also associated with stress, cigarette smoking and poor nutrition/vitamin deficiency as well as systemic illnesses including infectious mononucleosis, leukaemia, aplastic anaemia and agranulocytosis.

Aetiology of Vincent’s disease

Vincent’s disease is caused by a synergistic infection of Borrelia vincentii (Gram-negative spirochaete) and Fusobacterium spp. (Gram-negative anaerobes).

Diagnosis of Vincent’s disease

Clinical

Clinical signs and symptoms include:

Painful swollen bleeding gums with a characteristic grey/white membrane over the gums (a more diffuse pseudomembrane occurs on the buccal mucosa)
Ulcerated interdental papillae and marginal gingivae
Malaise, sometimes with fever and leucocytosis
Fetid breath
Punched-out, easily bleeding ulcers of the gums.

Vincent's disease

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Microbiology

Debrided gingival scrapings should be taken for Gram stain and anaerobic culture and sensitivity.
The organisms are difficult to culture, but Borrelia vincentii can be easily identified from Gram stain under the light microscope, and therefore Gram stain is the most useful diagnostic technique

Laboratory tests

Blood samples show:

Leucocytosis
Increased ESR.

Management of Vincent’s disease

Systemic antibiotic therapy and peroxide mouthwashes normally rapidly resolve the infection.

Metronidazole is a suitable first-line antibiotic for empirical treatment.

Once culture and sensitivity results have been obtained, antibiotic therapy may be amended as required. Dental treatment may be required.