Vincent’s angina, first described by Jean Hyacinthe Vincent in 1896, is an oropharyngeal infection caused by Borrelia vincentii (a spirochaete) in synergy with fusiform bacilli.
It typically presents as acute necrotizing ulcerative gingivitis (ANUG), a painful condition historically called “Trench Mouth” due to its prevalence among WWI soldiers.

📝 Also Known As

Acute necrotizing ulcerative gingivitis (ANUG)
Vincent’s angina / Vincent’s stomatitis
Fusospirochetal gingivitis
“Trench mouth” (historical term)

🧬 Aetiology & Pathogenesis

Mixed anaerobic infection: Borrelia vincentii + fusiform bacilli.
Triggered by poor oral hygiene, malnutrition, immunosuppression, or stress → gingival ulceration + pseudomembrane + halitosis.
Can extend to tonsils, pharynx, or larynx in severe cases.

⚠️ Risk Factors

Young adults, esp. during first dentition or exam stress 📚
Poor oral hygiene & smoking 🚬
Alcohol misuse 🍺
Malnutrition or vitamin deficiency (esp. vitamin C & B group)
Mental health conditions (neglect of hygiene)
Immunocompromise (HIV, diabetes)

🩺 Clinical Features

Gingival findings: red, swollen, ulcerated gums with grey pseudomembrane & spontaneous bleeding 🩸
Painful ulcers around gums and tooth margins
Halitosis: “fetor oris” – fetid breath 🤢
Tonsillar involvement: ulcerated areas on tonsils ± pseudomembrane
Systemic: low-grade fever 🌡️, malaise, regional lymphadenopathy (submandibular)

🔬 Investigations

Clinical diagnosis usually sufficient.
Bloods: WCC, CRP (may be mildly elevated).
Screen for underlying causes: diabetes, HIV, malnutrition.
Microbiology: swab culture rarely needed (fusospirochetal flora usually seen).

💊 Management

Supportive: Oral hygiene optimisation 🪥, improved nutrition, hydration, vitamin supplementation (e.g., Pabrinex if alcohol misuse).
Local therapy: Chlorhexidine 0.12–0.2% mouthwash (antiseptic).
Antibiotics (if systemic features or spreading infection):
- Amoxicillin 500 mg PO 8-hourly plus Metronidazole 400 mg PO 8-hourly
- Alternative: Doxycycline if penicillin allergy
Pain relief: Paracetamol / NSAIDs for discomfort.
Preventive: Regular brushing, dental hygiene education, smoking cessation, and alcohol moderation.

📊 Differential Diagnosis

Herpetic gingivostomatitis (HSV-1)
Aphthous ulcers
Oral candidiasis (thrush)
Leukoplakia / oral malignancy (chronic non-healing ulcers)
Diphtheria (if pseudomembrane tonsillitis)

📚 References

Vincent’s Angina – Case Report
BMJ Best Practice: Acute necrotizing ulcerative gingivitis
Oxford Handbook of Clinical Medicine – ENT infections section

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Vincent's angina

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