Necrotizing Gingivitis

Necrotizing gingivitis, also known as trench mouth, is a severe and painful infection of the gums. It is a type of periodontal disease that occurs when bacteria invade the gums and cause tissue death (necrosis).

The main symptoms of necrotizing gingivitis include severe pain, bleeding gums, bad breath, and the presence of a foul-tasting discharge. The gums may also appear red, swollen, and ulcerated, and there may be areas of dead tissue (necrosis) visible.


This condition is caused by a bacterial infection, typically by a combination of anaerobic bacteria, which thrive in low-oxygen environments. The primary causes of necrotizing gingivitis include:

  1. Poor oral hygiene: Inadequate brushing and flossing can allow bacterial growth in the mouth, leading to gum infections and periodontal disease. Neglecting oral hygiene can also lead to the buildup of plaque and tartar, which provide a fertile breeding ground for bacteria.
  2. Weakened immune system: Individuals with weakened immune systems, such as those with HIV, cancer, or uncontrolled diabetes, are more susceptible to infections, including gum disease. A weakened immune system may also fail to fight off the bacteria that cause necrotizing gingivitis.
  3. Stress: High levels of stress can affect the immune system and make it more difficult to fight off infections. Stress can also cause hormonal imbalances that can contribute to gum disease.
  4. Poor nutrition: A lack of essential nutrients, such as vitamin C, can weaken the immune system and lead to gum disease. A poor diet that is high in sugar and processed foods can also promote bacterial growth in the mouth.
  5. Tobacco use: Smoking and other forms of tobacco use can impair blood flow to the gums, making it more difficult for the body to fight off infections. Tobacco use can also cause inflammation in the gums, leading to the destruction of tissue.
  6. Drug abuse: Drug abuse, especially of substances like methamphetamine, can cause severe damage to the teeth and gums, increasing the risk of gum disease and necrotizing gingivitis.

It is important to seek prompt treatment if you suspect you have necrotizing gingivitis, as the condition can quickly progress and cause irreversible damage to the gums and teeth. Maintaining good oral hygiene, a healthy diet, and avoiding tobacco and drugs can help prevent the development of necrotizing gingivitis.


It is caused by an overgrowth of bacteria in the mouth, often due to poor dental hygiene, stress, malnutrition, or a weakened immune system. The main symptoms of necrotizing gingivitis are:

  1. Painful and swollen gums: The gums become red, tender, and swollen, and they may bleed easily when brushed or touched. The pain may be severe and can make it difficult to eat, talk, or swallow.
  2. Bad breath (halitosis): The infection produces an unpleasant odor in the mouth that can be difficult to eliminate.
  3. Ulcers and sores: Punched-out ulcers or craters may develop in the gum tissue, exposing the roots of the teeth. These ulcers are usually covered with a grayish film and are very painful.
  4. Fever and malaise: In some cases, necrotizing gingivitis can cause a fever and a general feeling of sickness.
  5. Loose teeth: As the infection progresses, the teeth may become loose or fall out due to the destruction of the bone that supports them.
  6. Pus and discharge: In severe cases, pus may collect in the affected areas, causing a foul taste and odor in the mouth.

If left untreated, necrotizing gingivitis can spread to other parts of the body and cause serious health complications. Therefore, it is essential to seek medical attention as soon as possible if you experience any of these symptoms. Treatment may involve antibiotics, pain management, and improved oral hygiene practices.


The main diagnosis test for necrotizing gingivitis includes a clinical examination of the gums, teeth, and supporting tissues, as well as a detailed medical and dental history.

The diagnosis of necrotizing gingivitis is typically based on the clinical presentation of symptoms such as severe gum pain, bleeding, and bad breath. A dentist or periodontist may also use specialized tools to measure the depth of gum pockets, assess the level of gum inflammation, and evaluate the extent of tissue destruction.

Other diagnostic tests for necrotizing gingivitis may include:

  1. Bacterial cultures: These tests help to identify the specific bacterial species responsible for the infection.
  2. Blood tests: Blood tests may be performed to check for signs of infection and to evaluate the immune response of the patient.
  3. Radiographs: X-rays may be taken to assess the bone and tooth structure, as well as to detect any underlying issues that may be contributing to the infection.
  4. Biopsy: In some cases, a small tissue sample may be taken for analysis to confirm the diagnosis and rule out other potential causes of the symptoms.

Overall, early detection and prompt treatment are critical in managing necrotizing gingivitis and preventing further complications.


The main treatment of necrotizing gingivitis involves a combination of medications and oral hygiene practices. The treatment includes:

  1. Antibiotics: The use of antibiotics is an essential component of the treatment of necrotizing gingivitis. The antibiotics prescribed can include amoxicillin, metronidazole, or clindamycin. Antibiotics should be taken as prescribed by the dentist or physician.
  2. Pain management: Pain management may be necessary to alleviate the discomfort associated with necrotizing gingivitis. Over-the-counter pain medications such as ibuprofen or acetaminophen can be used.
  3. Professional dental cleaning: A professional dental cleaning is necessary to remove the build-up of plaque and tartar from the teeth and gums. This will help reduce the bacteria that cause the infection.
  4. Warm saline rinses: Warm saline rinses can help to soothe the sore gums and promote healing. The patient should swish warm salt water in their mouth for 30 seconds to a minute, then spit it out.
  5. Oral hygiene: Good oral hygiene practices are critical in the treatment of necrotizing gingivitis. The patient should brush their teeth and gums gently with a soft-bristled toothbrush twice a day. Flossing should also be done at least once a day.
  6. Rest and hydration: Rest and hydration are important for the patient’s recovery from necrotizing gingivitis. They should drink plenty of water and get adequate rest to help their body fight the infection.

In severe cases, surgical intervention may be necessary to remove dead or damaged tissue. It is essential to seek treatment from a dental professional promptly to prevent the progression of the infection.