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February 2011, Volume 41 Number 2 , p 55 - 58


  • Dorothy S. Carlson DEd, RN
  • Ellen Pfadt PhD(c), RN


WHEN NURSES FIRST read the diagnoses Vincent angina and Ludwig angina, they may think of chest pain or anginal equivalent symptoms suggesting myocardial ischemia. True, angina pectoris is the most familiar type of angina. But angina, a Latin word for sharp, choking, or suffocating pain, also describes several disorders of the oral cavity caused by bacterial infections. Although similar, Vincent angina and Ludwig angina differ in location, clinical manifestations, and management. This article reviews both conditions and implications for nursing care.Known by various names, including acute necrotizing ulcerative gingivitis and trench mouth, Vincent angina is an acute bacterial infection of the gingiva caused by spirochetes, such as Borrelia vincentii, fusiform bacteria, or an overgrowth of normal oral flora. Predisposing factors include poor oral hygiene, advancing age, impaired nutritional status, smoking or chewing tobacco, immunosuppression, preexisting gingivitis, extreme stress, or lack of sleep.1-3 In this country, younger adults are most often affected, but in developing countries, it primarily occurs in children.4Vincent angina typically has an abrupt onset, starting with a shallow ulcerated area of the gingival oral mucosa and interdental papillae. The tissue is erythematous and edematous, with a characteristic gray appearance.2,5 The ulcerated area may become deeper and irregular and spread to the oropharynx. Without treatment, the gingivae may become necrotic.Initial signs and symptoms include halitosis; thick, increased oral secretions; bleeding gums; and localized cervical lymphadenopathy. The patient may complain of pharyngitis, otalgia, pain in the affected area, a foul taste in the mouth, and sometimes a choking sensation-hence the term "angina."If the condition progresses, the periodontium may be destroyed. Possible systemic manifestations include fever, anorexia, weakness, and fatigue.2,5Patients may be treated by a dentist or periodontist who performs

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