 Hello everyone, welcome back to another session in the industry and more topic for today is trench mob disease trench mob disease is nothing but acute Necrotizing ulcerative gingivitis, which is a rare condition and is characterized clinically by a few things such as Necrosis of free gingival margin the crest of gingiva and the interdental papilla these three things necrosis will be happening Which are there one is free gingival margin then the crest of gingiva and interdental papilla Which has got many synonyms one. I told you acute Necrotizing ulcerative gingivitis then when sense infection then acute ulceromembraneous gingivitis Then fuso spiro ketal gingivitis So it is an epidemic pattern it is having an epidemic pattern and it was first Seen as a epidemic during the first world war among the soldiers who are in trends. So that is how it got that name trench mob disease and it has got increased prevalence associated with HIV infection and It is more commonly seen on the young and middle-aged at that is around 15 to 35 years So what could be the etiology of this trench mob disease? So most of the investigators believe that it is caused by a fuciform bacillus bacteria fuciform bacillus and Borrelia wins and a spiro ket Cindy which is a spiro ket and It is frequently occurs in presence of stress that is psychological stress So we are talking about the etiology of trench mob disease one is fusiform bacillus and Borrelia wins and a then psychological stress So this stress-related corticosteroids are thought to alter the T4 and T8 Lymphocyte ratio and may cause a decreased neutrophilic Chemotaxis and phagocytic response So chemotaxis and phagocytic response will be Decreased and it can be also seen in people with immuno suppression or People with smoking, local trauma, poor nutritional status, poor oral hygiene, inadequate sleep Or people with debilitating disease such as infectious mononucleosis Diabetes or People with Down syndrome So what are the clinical features? So clinical features this more seen in The mails and Geneva becomes red and painful Red and painful And the characteristic feature is it looks like a punched out erosion of the enda dental papilla Punched out erosion That is the most characteristic feature of Anac or trench mothosis So Geneva often covered by a pseudo membrane. That is why it was called the two names pseudo membrane and punched out in trench mothosis So the pseudo membrane it has a pronounced bleeding tendency and always produces extremely unpleasant Fitted order. So all are the characteristic features of trench mothosis and Rarely the djuncha volition may extend to the mucosal surfaces of soft palate and tonsils and patient often develops headache fever malleys and lymphadenopathy and there will be always difficulty in taking food because of this increased salivation and There will be a metallic taste in the mouth and most of the patients develop systemic manifestation in the form of leukocytosis Leucocytosis then tachycardia and other gastrointestinal disturbances So sometimes it leads to loss of attachment and the development of associated periodontitis. That is necrotizing ulcerative So this leads to this Necrotizing ulcerative periodontitis and If it spreads to adjacent soft tissue, it is known as necrotizing ulcerative mucocytus Necrotizing ulcerative mucocytus or Necrotizing stomatitis So if the necrotizing infection extends through the mucosa to the skin of the face, it is typically termed as noma or Cancrum or That is the necrotizing infection extends through the mucosa to the skin of the face that this has got the name cancrum or is so Necrotizing ulcerative gingivitis will become necrotizing ulcerative periodontitis and it can become When it spreads to soft tissue, it will be necrotizing ulcerative mucocytus or necrotizing stomatitis When it spreads to the face, it is known as noma or cancrum or is And how do we treat the trench mob disease? So basic treatment objectives are the alleviation of acute inflammation by reducing the microbial load and removal of all those necrotic tissue then alleviation of the generalized problems such as fever and malaise and other correction of systemic conditions Which contributes to the initiation or progression of gingival change? So we can do in multiple visits the first visit We need to reduce the microbial load and remove necrotic tissues. That is reduction of microbial load and removal of necrotic tissues So complete evaluation of the patient should be done and treatment of acute radiation as a primary goal Topical anesthetic can be applied then for two to three minutes then Gently we can do the swabbing Remove the pseudo membrane and other non attached surface debris and clean with warm water Then ultrasonic scaling may be preferable with minimal pressure against the soft tissue then subgingival scaling and curatage Can be performed during the first visit But the problem of this subgingival scaling there are chances of infection to be spread To the deeper tissues and it can cause Bacteria and we can also put the patient into antibiotics such as amoxicillin 500 m3 For 10 days or erythromycin or metronarizol twice for seven days Then we need to instruct the patient Not to take alcohol or tobacco then ask the patient to rinse the mixture of three percentage hydrogen peroxide and warm water every two hours or twice daily or Also, he can use point one two percentage chlorhexidine And always a patient should get adequate rest and avoid excessive physical activities and Confine the tooth brushing we should instruct to confine the tooth brushing to do removal of surface debris with a bland dentifrice and an ultra soft brush and Analgesics can be prescribed and the sites During the second visit that is after two days the patient is evaluated for the resolution of signs and other symptoms lesion it is erythematos without a superficial pseudo membrane and There will be shrinkage of ginger which may expose the previously covered calculus, which is gently removed And we can repeat the instructions of the first visit So in second visit only thing is we need to evaluate properly of the lesion and if there is any interval shrinkage Cleaning or the scaling can be done On third visit that is after this is after two days Then this is after five days That is after second visit that is maybe It take a long time for the third visit So patient is evaluated again for the symptoms and a comprehensive plan for the management of patient's Pyrrhodontal condition is formulated at this stage Again the hydrogen peroxide rinsing and chlorhexidine mouthwash can be continued and all other supportive therapy such as a wrist Appropriate fluid intake and soft and nutritious stat and also we can perform the scaling and root planning only if required and patient should be Re-instructed about the plaque control measures and proper counseling regarding the nutrition and smoking cessation and We can start the treatment for pockets or the flap or other procedures and then patient should be revalued after one month So that is how we manage the trench mouth and we can contour the ginger using Surgical methods just plastic surgery Or any other technique we can use so basically It takes one month time for this disease to get cured But it depends on also factors patients health systemic factors local factors patients habits and The diet and the proper management of this place So all these can bring back the condition almost to normal so that is all about the trench mouth This is it's commonly our short note in oral pathology. So I'll come up with a new topic in the industry. Thank you