The Vincent 's angina is acute, ulcerative gingivitis and necrotizing perforating characterized by pain, tissue destruction, malodor (halitosis) and formation of a white-greyish pseudomembrane covering ulcerations.
Vincent's angina is also known as "trench mouth", "trench disease" (probably because it was a condition present in some soldiers in World War I), "Vincent's disease", "pseudomembranous angina", "gingivitis acute necrotizing ulcer ”and“ spirochetal angina ”.
Photograph of a patient with gingivitis (Source: Onetimeuseaccount, via Wikimedia Commons)
Vincent's angina lesions can spread and involve the oral mucosa, lips, tongue, tonsils, and pharynx. It can cause dental pain, fever, bad taste in the mouth and lymphadenopathy in the neck. It is not a contagious condition.
It occurs most frequently between the second and third decade of life, particularly in the context of poor oral hygiene, scurvy, pellagra or malnutrition, smoking or chewing tobacco, situations of intense psychological stress, severe insomnia, and weak immune system.
In poor countries with high rates of malnutrition, this disease affects a wider range of the population, including young children, especially those who are malnourished in the poorest areas.
The term "angina" is a Latin word used to describe acute and suffocating pain, which describes the pain that occurs in this disease.
History
This disease has been observed and described for centuries. Xenophon, in the 4th century BC. C., described that some Greek soldiers had pain in the mouth and bad breath. Hunter, in 1778, described the disease to differentiate it from scurvy (vitamin C) and chronic periodontitis.
Jean Hyacinthe Vincent, a French physician at the Pasteur Institute in Paris, described a spirochetal infection of the pharynx and palatine tonsils that causes pseudomembranous pharyngitis and tonsillitis. Later, in 1904, Vincent described the same microorganism as causing ulcer-necrotizing gingivitis.
The use of the term “trench mouth” is due to the fact that the disease was frequently observed in soldiers on the front lines in the First World War. At the time it was thought that, in part, it was due to the extreme psychological stress to which these soldiers were exposed.
This same condition was observed in civilians during the bombing periods, people who were far from the war front and who had relatively good diets, assuming that psychological stress was an important factor related to the disease.
In the late 1980s and early 1990s, a periodontal disease was described, observed in severely affected patients with AIDS and strictly related to HIV, giving it the name of “HIV-associated periodontitis”.
It is currently known that this association with HIV / AIDS is due to the immunosuppression status of these patients, and that the high prevalence of Vincent's angina is shared with patients suffering from other diseases associated with depression of the immune system.
Symptoms
Vincent's angina is a common, non-contagious gum infection that comes on suddenly and is classified as a necrotizing periodontal disease. The characteristic gum pain present in this disease differentiates it from chronic periodontitis, which is rarely painful.
In the initial stages, patients may report a sensation of pressure or tightness around the teeth. Then the frank symptoms appear quickly. Three signs and / or symptoms are necessary to make the diagnosis, these are:
1- Intense pain in the gums.
2- Profuse bleeding of the gums that can appear spontaneously or by insignificant stimuli.
3- Inflamed and ulcerated interdental papillae, with necrotic tissue, which has been described as “perforating ulcers” and the presence of grayish-white pseudomembranes that cover the ulcerations.
Another symptom that may be present is bad breath (halitosis), a bad taste in the mouth, described as a “metallic taste”, general malaise, fever, etc. Sometimes painful nodules may appear in the neck (lymphadenopathy).
Ulcerative necrotizing gingivitis (Source: Dr. Mohamed HAMZE via Wikimedia Commons)
The pain is very well localized in the areas of injury. Systemic reactions are much more pronounced in children, and much more intense pain with deeper lesions is seen in patients with HIV / AIDS or with disorders involving a weakening of the immune system.
The lesions can extend to the oral mucosa, tongue, lips, tonsils, and pharynx. Generally, lesions on the tonsils are usually unilateral.
Causes
Necrotizing gingivitis or Vincent's disease is part of a wide spectrum of diseases called "necrotizing periodontal diseases", of which it is the smallest in its range, since there are more advanced stages such as necrotizing periodontitis, necrotizing stomatitis and in the extreme more serious is cancrum oris or oral cancer.
The main microorganisms involved in causing Vincent's angina are anaerobic bacteria such as bacteroides and fusobacteria; The participation of spirochetes, borrelias and treponemes has also been described.
Some authors describe it as an overpopulation of microorganisms that grow and multiply, promoted by poor oral hygiene, smoking and poor diet, coupled with debilitating disorders, mainly stress or diseases that weaken the immune system.
It is an opportunistic infection that occurs in a background or local deterioration of the host's defense system. The area of injury from the surface to deeper areas has been described in several layers such as: bacterial area, area rich in neutrophils, necrotic area and spirochetal area.
Although the diagnosis is usually clinical, a smear to demonstrate the presence of spirochetes, leukocytes, and occasionally blood is also indicated. This allows a differential diagnosis to be made with other very similar pathologies, but of viral origin.
Treatment
Treatment in the acute phase consists of removing or debriding dead or necrotic tissue and irrigating the injured area. Sanitize the oral cavity using antiseptic mouthwashes and local or systemic pain medication.
If there is general symptoms such as fever, malaise, etc. or dissemination of the lesions to neighboring areas, the use of antibiotics such as metronidazole is indicated. Improving oral hygiene and providing a balanced diet is essential to prevent recurrence.
Forecast
If the infection is not treated quickly, periodontal destruction can occur and can spread as a necrotizing stomatitis in the neighboring tissues of the oral mucosa, tongue, lips, tonsils and pharynx and can even affect the jaw bone.
As already indicated, this condition can be favored and is especially dangerous in patients with a weak immune system. The progression of the disease to more advanced stages can cause severe deformations.
If the patient is treated properly and on time, and good oral hygiene and adequate nutrition are also introduced, the process reverses and heals without any important sequelae, so it has a good prognosis.
References
- American Academy of Periodontology (1999). "Consensus report: Necrotizing Periodontal Diseases". Ann. Periodontol. 4 (1): 78. doi: 10.1902 / annals.1999.4.1.78
- Behrman, R., Kliegman, R., & Arwin, A. (2009). Nelson Textbook of Pediatrics 16 ed. W.
- Carlson, DS, & Pfadt, E. (2011). Vincent's Angina and Ludwig's Angina: Two Dangerous Oral Infections. Nursing (Spanish Ed.), 29 (5), 19-21.
- Scully, Crispian (2008). Oral and maxillofacial medicine: the basis of diagnosis and treatment (2nd ed.). Edinburgh: Churchill Livingstone. pp. 101, 347. ISBN 9780443068188.
- Wiener, CM, Brown, CD, Hemnes, AR, & Longo, DL (Eds.). (2012). Harrison's principles of internal medicine. McGraw-Hill Medical.