Vincent’s angina (acute necrotising ulcerative gingivitis; “trench mouth”)
Overview
Vincent’s angina is an acute, ulcerative, necrotising infection of the gingiva caused by a polymicrobial anaerobic flora.
Terminology varies: “ANUG” (acute necrotising ulcerative gingivitis) is often used for disease confined to the gingiva, while the term Vincent’s angina is sometimes reserved for cases with extension to the pharynx or tonsils.
The condition is usually diagnosed clinically and ranges from a painful self‑limited gingivitis to a rapidly progressive infection requiring urgent dental/maxillofacial or ENT input.
Pathogenesis and risk factors
- Microbiology: Mixed anaerobes (fusobacteria, Bacteroides spp., spirochaetes) from normal oral flora become pathogenic in permissive conditions.
- Predisposing factors: Poor oral hygiene, smoking, recent viral illness, malnutrition, severe stress, and immunosuppression (HIV, neutropenia, malignancy). Historically associated with overcrowding and poor sanitation (“trench mouth”).
- Pathology: Rapid necrosis and ulceration of interdental papillae and gingival margins with formation of a grey pseudomembrane, foul odour, and regional lymphadenopathy. Spread can involve adjacent oropharyngeal structures.
Clinical presentation
- History: Acute severe gum pain, bleeding, and rapid progression over days; marked halitosis is typical. Systemic features range from none to fever and malaise, with higher fevers in more extensive disease.
- Examination findings:
- Necrosis and ulceration of interdental papillae and gingival margins with a greyish pseudomembrane.