Letters to the Editor

We present here a case of a patient with necrotizing gingivitis associated with a suspected COVID-19 infection.

Necrotizing gingivitis is characterized by the three acute clinical features (papilla necrosis, bleeding and pain) and are strongly associated with impaired host immune responses.

Necrotizing gingivitis, also known as Trench-mouth, was typically seen during World War I; and was ostensibly due to multiple risk factors, including poor oral hygiene, psychological stress and malnutrition. In more recent times, it has presented with a lesser frequency within the general population, often seen in an immunocompromised patient, such as those suffering from HIV.

A 35-year-old woman attended the King's College Hospital dental emergency unit reporting a history of fever, intense gingival pain, bleeding gums and halitosis. The fever presented first followed by the oral symptoms 3 days later. She reported no other systemic symptoms or symptoms suggestive of COVID-19. As a result of the pain, the patient was having difficulty eating. The pain was constant, affecting her sleep, and paracetamol did not provide any analgesic benefit. She was medically fit and well, with no known allergies and taking no regular medication. She was a non-smoker, working from home as an auditor for a global advisory firm. She had no risk factors for HIV. She followed good oral hygiene habits, brushing twice daily and flossing once a day, and had started using an alcohol-containing mouthwash. Her last dental visit was 12 months previously, which included a session with the hygienist.