What is the treatment for Vincent stomatitis?

Treatment for Vincent Stomatitis (Acute Necrotizing Ulcerative Gingivitis)

Initiate treatment immediately with oral penicillin V (250-500 mg four times daily) combined with aggressive mechanical debridement and meticulous oral hygiene using non-alcoholic mouthwashes. 1

Antimicrobial Therapy

• Penicillin V is the first-line antibiotic for fusospirochetosis (Vincent's gingivitis and pharyngitis), as it targets the causative fusiform bacteria and spirochetes that characterize this anaerobic infection 1
• The FDA-approved indication specifically covers mild to moderately severe infections of the oropharynx caused by these organisms 1
• Alternative antimicrobial therapy includes intravenous metronidazole for severe necrotizing stomatitis, particularly in malnourished or immunocompromised patients who present with extensive tissue necrosis 2
• The infection represents a mixed anaerobic bacterial process involving fusibacteria and spirochetes, which requires targeted antimicrobial coverage 3

Mechanical Debridement and Dental Care

• Professional dental debridement is essential and must be performed alongside antibiotic therapy to remove necrotic tissue and bacterial plaque 1
• All calcified plaque (calculus) must be mechanically removed by the dentist, as antimicrobials alone are insufficient 4
• Any sharp edges or ill-fitting dental prostheses should be eliminated before or during treatment, as these sources of trauma perpetuate the condition 5

Oral Hygiene Protocol

• Use 0.9% saline or sodium bicarbonate rinses (1 teaspoon salt with three-quarter teaspoon baking soda in 500 mL water) 4-6 times daily to maintain oral pH and reduce bacterial load 6, 7
• Non-alcoholic mouthwashes are mandatory, as alcohol-containing products aggravate mucosal injury 5, 6
• Consider adding 0.2% chlorhexidine digluconate mouthwash twice daily for additional antimicrobial coverage in moderate to severe cases 7

Supportive Care Measures

• Consume only soft, moist, non-irritating foods that are easy to chew and swallow; avoid acidic, spicy, salty, or rough foods 5, 6
• Maintain adequate hydration by drinking plenty of water throughout treatment 5, 6
• Use ice chips or ice pops to numb the mouth and reduce discomfort 6, 8
• Apply lip balm for dry lips and consider salivary substitutes if xerostomia is present 6, 7

Pain Management

• Topical anesthetics such as viscous lidocaine 2% can be applied for localized pain control 6, 8
• Mucosal coating agents and benzydamine HCl provide additional symptomatic relief 8
• For severe pain, consider systemic analgesics (acetaminophen or NSAIDs) rather than topical agents alone 8

Management of Severe Cases

• Hospitalization is required for patients with inability to maintain oral intake, severe tissue necrosis, or systemic signs of infection 6, 2
• Intravenous metronidazole should replace oral penicillin in hospitalized patients with extensive necrotizing lesions 2
• Nutritional support is critical, as malnutrition is a major predisposing factor for necrotizing stomatitis and impairs healing 2, 9
• Scrupulous debridement of all necrotic tissue must be performed to prevent progression to devastating facial defects 2

Critical Pitfalls to Avoid

• Do not delay antimicrobial therapy while awaiting culture results, as Vincent stomatitis requires immediate treatment to prevent tissue destruction 1, 3
• Avoid using corticosteroids before ensuring adequate antimicrobial coverage, as steroids can worsen the underlying anaerobic infection 7
• Do not rely on antimicrobials alone without mechanical debridement—the combination is essential for treatment success 1, 4
• Recognize that poor oral hygiene, stress, inadequate sleep, and immunosuppression are significant predisposing factors that must be addressed to prevent recurrence 9

Follow-Up Care

• Continue meticulous daily oral hygiene even after clinical resolution to prevent recurrence, as patients with Vincent stomatitis are plaque-intolerant 6, 8
• Monitor for healing with intact epithelium and resolution of necrotic ulcers 8
• Address any underlying nutritional deficiencies, immunosuppression, or systemic conditions that contributed to the initial infection 2, 9
• Perform mouth-opening exercises if trismus develops secondary to fibrosis during healing 2