A 37-year-old male patient presented with severe pain and bleeding of gingiva with inability to eat spicy food for 6 days. The patient was systemically healthy, but a heavy smoker for 3 years (15 cigarettes per day) and also under heavy stress due to family problems. He also complained of “metallic” taste and “pasty” saliva. Intraoral examination revealed necrotizing lesions of maxillary and mandibular gingiva, with the surface covered by white pseudomembrane slough (Figure, black arrows). Bilateral submandibular lymph nodes were tender on palpation, and there was increased body temperature of 103°F. Panoramic radiograph showed no loss of alveolar bone. Blood analysis was normal and the HIV serostatus was negative. The diagnosis arrived at was Trench mouth, or Vincent’s gingivostomatitis – after taking into consideration the clinical features and eliminating a similar condition called primary herpetic gingivostomatitis caused by herpes simplex virus-1 – seen predominantly in children with vesicle formation of the gingiva. The patient was advised to stop the smoking habit. Treatment consisted of removal of the pseudomembrane and the necrotic part of gingiva under local anesthesia, with the patient advised to take adequate rest and proper diet. He was prescribed amoxicillin 500 mg and paracetamol 325 mg every 6 hours for 5 days, and local application of metronidazole gel 3 times a day for 5 days. For maintenance of oral hygiene, the patient was advised to rinse his oral cavity with 3% hydrogen peroxide and sterile warm saline (1:1) 4 times a day, along with 0.12% chlorhexidine mouthrinse for 7 days. One-year follow-up revealed completely healed gingiva with no recurrence of the lesion.
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-Tanay Chaubal, MDS (Periodontology and Oral Implantology), Ranjeet Bapat, MDS (Periodontology and Oral Implantology)
This article originally appeared in the November 2017 issue of The American Journal of Medicine.
