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Workers in the field of periodontal disease now agree that breakdown in the mouth is the result of a complex of local and systemic factors, with no single
cause for all cases. In many cases, local mechanical and bacteriological treatment has been successful, but in others the disease persists or recurs in spite of all such efforts, and the role of emotional factors has come to be recognized. Vincent's infection is now regarded as not a communicable disease in the usual sense. It is felt that epidemics occur where many people live under the same conditions as, for example, in army life, where outbreaks follow excessive fatigue, stress, or anxiety.
Twenty-two cases were studied by a psychiatrist, a periodontist, and a dental consultant in a large clinic. Six had acute necrotizing gingivitis (Vincent's), and sixteen had chronic periodontitis. Oral dependency was the one outstanding pattern in all cases except one, the oldest and the only diabetic patient. Hostility was prominent in a number of the older patients; it apparently staved off the breakdown until a later age. Ten of the twenty-two cases showed a marked lack of parental care, due to death, desertion, or neglect; seven had been much babied at home; and five others gave a strong impression of immaturity. All showed pronounced oral habits. Nine were aware of increased bleeding of the gums with overt anxiety. Five women noted increased bleeding of the gums at the time of the menses; three others dated the onset of gingival bleeding to the menarche.
All six cases of Vincent's infection seemed clearly to have been precipitated by acute anxiety; the sudden outbreak came after days or weeks of gradually gathering impetus. The two youngest girls were away from home for the first time and were mobilizing their conflicts about needing mother and home. A boy was impotent in attempting intercourse with an older woman, and the acute necrotizing gingivitis appeared a few days later. He feared homosexuality and