Vincent’s angina
Vincent’s angina is another uncommon but important diagnosis not to be missed in patients attending the ED
It is also known as trench mouth or acute necrotising ulcerative gingivitis and is defined as an acute febrile, pseudo-membranous inflammation of the gingiva secondary to bacterial infection.
The aetiology is unclear but is thought to be due to superinfection with anaerobic bacteria such as bacteroides, fusobacterium and spirochetes which are normal mouth flora.
It is now more commonly found in patients with immunodeficiency states such as malnutrition and HIV infection.
The infection starts as inflammation, usually on one side of the mouth, which spreads along the gingival margins and may affect the pharynx and lips. This leads to gum atrophy, ulceration, enlarged lymph nodes and formation of a grey pseudo membrane, which may lead to it being confused with diphtheria.
ED treatment consists of:
- Chlorhexidine mouth washes
- A 3-day course of metronidazole or amoxicillin
- Encouragement to improve oral hygiene
Patients should be advised that they need urgent assessment and management by a dentist.