RT Book, Section A1 Jauch, Edward C. A1 Valdez, J. Amadeo A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181040678 T1 Trench Mouth (Acute Necrotizing Ulcerative Gingivitis) T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181040678 RD 2024/10/06 AB Painful, severely edematous interdental papillae are characteristic of acute necrotizing ulcerative gingivitis (ANUG), or trench mouth. Other associated features include the presence of ulcers with an overlying grayish pseudomembrane and a “punched out” appearance. The inflamed gingival tissue is friable and necrotic and represents an acute destructive disease process of the periodontium. Fever, malaise, and regional lymphadenopathy are commonly associated signs. Patients may also complain of foul breath and a strong metallic taste. Poor oral hygiene, emotional stress, smoking, and immunocompromised states (eg, HIV, steroid use, diabetes) all predispose for ANUG. Anaerobic Fusobacterium and spirochetes are the predominant bacterial organisms involved. The anterior incisor and posterior molar gingival regions are the most commonly affected oral tissues. Acute herpetic, gonococcal, or streptococcal gingivostomatitis, aphthous stomatitis, desquamative gingivitis, and chronic periodontal disease may mimic ANUG.