INFECTIONS in the mouth vary in severity, according to a person’s susceptibility and resistance.
Generally, the healthier you are, the more resistant you are likely to be; but even where general health is good, the health of the gums may be poor. Many times, a balance is reached between the host (you) and the invading organisms (germs), in which case, a standoff or impasse occurs. The condition then becomes chronic, ever-present, but in a rather mild form.
In addition, many dental infections are due, not to the introduction of new organisms, but, to an increase in the virulence of the viruses and bacteria normally present in the mouth, particularly as your resistance decreases.
This notwithstanding, it is well established that the so-called French kissing and oral sex could transfer and introduce new types of bacteria from one person to another. In fact, the famous actor, Michael Douglas recently admitted to the American media that he contracted throat cancer from having oral sex. This is quite possible, and probably more common that is believed.
However, because we are all likely to have the same organisms in our mouths, the more common dental infections are not contagious. In most cases, it is lowered resistance to our own bugs rather than invasion by others that causes most diseases of the mouth.
The worst oral infection I’ve ever encountered as a dentist for over two decades is Trench Mouth, also called Vincent’s Infection, and even ANUG (acute necrotizing ulcerative gingivostomatitis).
Not long ago, a patient died of this condition after the erroneous management of a dentist on the East Bank of Demerara. Marginal gingivitis is frequently a precursor of the ulceration and degeneration (or necrosis) of the gums that characterizes ANUG.
The interdental papilla between each tooth looks “punched out”, and the surrounding gum cuff is loose and raw. The odour coming from the mouth is extremely offensive, and this alone gives the dentist an accurate diagnosis.
If untreated, or if superimposed on a more serious illness that affects gum tissue, such as anemia or leukemia, ANUG becomes progressively worse, destroying the underlying periodontal bone and extending to other tissues.
Such extensive infection is not seen often, since the disease responds well to therapy. In addition, unless the person is isolated from civilization, help is usually sought from early onset.
Microscopic examination of infected tissues reveals an unusually large number of fusiforms and spirochetes, bacteria that are always present in our mouth, though normally in lesser numbers.
ANUG is associated with lowered resistance, stress, poor nutrition, and poor oral hygiene. I saw many such cases when I worked as the dentist for the Mazaruni Prison.
Trench Mouth is often seen among young persons, especially during adolescence and the early twenties. In World War I, it cropped up in epidemic numbers among the troops in trenches, giving rise to the term “trench mouth”.
Epidemic outbreaks also occur among students during examination week. However, the epidemic is not caused by the communication of the fusospirochetes to others, but by the shared stress, fatigue, and neglected oral hygiene that help lower the resistance of many members of group simultaneously.
The tissue is covered by a gray pseudornembrane that peels off, leaving a red, raw surface that bleeds easily, and is extremely painful to the touch. There is usually a foul smell, and the patient frequently has a fever and feels listless.
The infection is not contagious; it responds quickly to antibiotics, usually penicillin. Simpler remedies, such as frequent rinsing with a dilute solution of hydrogen peroxide are also effective. Scaling of the teeth to remove sub-gingival calculus and plaque is also necessary to reduce the infection, and prevent recurrence. Without dental prophylaxis and adequate oral hygiene, the condition settles in as a sub-acute or chronic infection, with acute flare-ups during periods of stress.
Another condition which is not so common is canker sore, which usually occurs in the soft fold of mucosal tissue at the junction of the inside of the cheeks and the gums, and the inside of the cheeks and the lips. They also occur on the soft palate, the side of the tongue, and ‘floor’ of the mouth. They seldom occur on the gingiva and the hard palate, common sites for herpes simplex ulcers.
Minor apthous ulcers measure from a few millimeters to a centimeter (nearly half an inch) in diameter, whereas major apthous ulcers can be as large as two centimeters.
Beginning as small red areas, the center portion sloughs to create a crater that is yellow or grayish white in color. Although these ulcers usually occur as a single sore, multiple lesions may be present.
The exact cause of canker sores is unknown. Stress may bring on attacks in susceptible persons. Biting the inside of the cheek or lip may incite an ulcer. The tissue may be traumatized by the bristle of a toothbrush or the prick of a bone fragment while eating. Some patients develop a canker sore following a dental appointment, no matter how gentle the treatment.
Nutritional deficiencies may account for recurrent lesions in some people. But the underlying cause is more likely related to an immunologic dysfunction in which antibody-producing cells attack rather than protect the healthy oral tissues.
The ulcer is particularly painful if located on highly mobile surfaces such as the tongue or the mucobuccal folds on the inside of the cheeks. Eating, careless toothbrushing, and even speaking may be acutely painful. Spicy and acidic foods also irritate the ulcers.
Small canker sores are not too painful, and they usually do not require treatment. They disappear in a week or two. Large ulcers, however, can be extremely painful. Temporary relief may be obtained by applying topical anesthetic ointments, which are available in drug stores without prescription.
Topical steroids have been used with limited success, because the ointments do not adhere for very long to the ulcer. Moreover, the ulcer itself cannot be kept dry because of saliva. An oral suspension, combining tetracycline and nystatin, has been used with some success, possibly because it eliminates secondary bacterial infection.
Overall, however, there is no treatment that is consistently reliable. This is not of critical importance since the disease is self-limiting and recurs less often with age.