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Dental Emergency And Acute Perio Conditions

Acute periodontal conditions are a set of rapid-onset ailments that affect the oral cavity. As opposed to gingivitis or periodontitis, which are chronic infections, these conditions can be associated with pain or discomfort, and may have immediate systemic manifestations. The symptoms of acute periodontal conditions can be so severe as to create a dental emergency Gingival Abscess

An abscess is a gathering of pus in an infected area. A gingival abscess is a painful swelling of the gum that may appear to be red and shiny. It is tender to touch and can have pus draining from it. It can be caused by bacterial plaque or a foreign object embedded in a sensitive area. Treatment involves draining the pus and cleaning the abscess thoroughly. The area needs to be numbed for patient comfort, and if promptly treated, gingival abscesses should not leave any scarring or long-term complications.

Periodontal Abscess

A periodontal abscess exhibits similar signs and symptoms as a gingival abscess, but with the infection involving the bone and tissues that support the tooth. The involved tooth can become mobile and sensitive to touch due to rapid bone loss around it. To treat a periodontal abscess, the area needs to be numbed and the abscess drained. The tooth may need to be scaled in order to remove the irritants that caused the infection. It may be necessary to irrigate the abscess with special antimicrobial solutions or to take systemic antibiotics. The tooth may need to be adjusted so that the bite is more comfortable. If the abscess is severe, it may require surgical treatment or even removal of the tooth. A thorough periodontal evaluation is recommended after a dental emergency treatment to identify other possible problem areas.

Periodontal/Endodontic Abscess

This is a combined infection of the gum, bone, and the nerve in the root canal of the tooth. It can be caused by a gum infection that progressed to the tip of the tooth, infecting the nerve in the root canal, or by a nerve infection that is draining through the gum tissue. Either way, the signs and symptoms are the same as with a periodontal or gum abscess. This type of periodontal treatment may include periodontal (as above) and/or root canal therapy.

Acute Necrotizing Ulcerative Gingivitis (ANUG)

Painful ulcers that bleed easily characterize this generalized, acute condition of the gums. Bad breath can also be present, and systemic manifestations include fever and lymph node enlargement. ANUG is associated with stress, smoking, poor nutrition, and people with immunodeficiencies (including HIV). Untreated ANUG can progress to NUP (necrotizing ulcerative periodontitis), in which there is bone loss around the teeth and eventually tooth loss. Treatment of ANUG includes a cleaning of the teeth and irrigation of the gums. Plaque control is very important after initial treatment. If it is difficult to brush or floss, oral rinses may be prescribed. Antibiotic treatment may be necessary if there is systemic involvement such as fever.

Herpetic Gingivostomatitis

This is another generalized acute condition of the gums and soft tissues of the mouth. It is an infection caused by the herpes simplex virus. There may be multiple ulcers and fever. Swollen lymph nodes and malaise may also be associated with herpetic gingivostomatitis. This condition is self-limiting and resolves in 10 to 15 days. For patient comfort, treatment includes application of a numbing agent (topical anesthetic) and a thorough cleaning of the ulcers. This is followed by oral hygiene instructions and proper nutritional intake information. Under some circumstances, antiviral medications may be prescribed. Herpetic gingivostomatitis is contagious, and intimate contact should be avoided during the healing period.

Pericoronitis

This is an inflammation and infection of the tissues that cover the chewing surfaces of the teeth that are not fully erupted. The gums in that area can be red, swollen, and painful to touch. It also may be difficult to open the mouth. In addition, there can be a discharge of pus. Like with all other infections, pericoronitis can spread and create further systemic complications like lymph node enlargement, fever, and malaise. Pericoronitis is treated with a thorough cleaning and irrigation of the affected area. It may be necessary to surgically reshape the gum around the partially-erupted tooth or to remove the tooth. Antibiotic treatment also may be necessary.

Acute periodontal conditions may be manifestations of pre-existing periodontal problems that result in an acute problem and a dental emergency. The best way to prevent dental emergencies is to maintain oral health and to visit your dental care provider routinely for examinations.

By Laura Minsk, DMD

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Gingivitis - Everything You Need To Know

Gingivitis is the most common periodontal disease, affecting 90% of the population. It is an infection of the gums caused by bacteria that form plaque.

In small amounts (when it is newly formed), plaque is invisible and relatively harmless. But when left to accumulate, it increases in volume and the proportion of harmful bacteria grows. These gingivitis bacteria release toxins that result in inflammation of the gum tissue and bad breath.

Eventually, the plaque hardens and forms hard deposits called calculus or tartar. If not properly treated, gingivitis may progress to periodontitis, a periodontal disease in which there is loss of the bone that supports the teeth.

Signs of Gingivitis

Gingivitis can be identified by red or swollen gums. In some circumstances, the gingivitis can cause bleeding gums when brushing or eating, and there may be bad breath. To diagnose gingivitis, a dentist may probe gently under the gums. In healthy gums, there should not be any bleeding with this gentle probing. A bleeding gum indicates that there is gum inflammation or gingivitis.

Who's At Risk for Gingivitis?

Certain people are more susceptible to gingivitis. Stress, smoking and poor nutrition can contribute to the development of gingivitis. Certain medications such as steroids, heart medications, cancer therapy drugs, anti-epilepsy drugs, and anti-depressants also increase the risk for gingivitis.

In the presence of plaque, these medications can lead to gum overgrowth. The enlarged gums can further interfere with oral hygiene, precipitating a vicious cycle of further gum enlargement.

Changes in female hormones can also increase the vulnerability to gingivitis. Adolescent women, pregnant women and women who take hormone replacement or birth control pills also have a greater risk of developing gingivitis.

There are several systemic illnesses that are associated with gingivitis. These include

• acute leukemia
• Addison's disease
• diabetes
• hemophilia
• immunodeficiency diseases (including HIV)

The swelling and redness of the gums may be disproportional to the amount of plaque present. To prevent further complications, meticulous plaque control is critical for people with these illnesses.

Gingivitis Treatment

For gingivitis treatment, the bacterial plaque and tartar have to be removed from the surfaces of the teeth by a dentist or hygienist. Then, the factors that contribute to plaque retention have to be altered in order to facilitate oral hygiene procedures.

This can involve re-shaping existing restorations or even moving teeth with braces so that they are not crowded. Essential to the success of the gingivitis treatment is the person's ability to control plaque build-up after initial treatment. Daily brushing and flossing are key to gingivitis prevention and helps prevent bad breath.

If there is a lot of gum inflammation, if the gums are very sensitive, or if there is a lot of tartar buildup, it may be necessary to numb the gums in order to remove the buildup of bacteria underneath the gum margins. If the gum is very inflamed and swollen, it may be necessary to remove some of the excess gum tissue surgically.

Gingivitis is reversible, and with proper gingivitis treatment and maintenance, it can be controlled. However, untreated gingivitis can result in gum defects, bone loss around the teeth, and eventual tooth loss and systemic complications. The best way to prevent gingivitis is by brushing and flossing daily, and by visiting the dentist for a routine cleaning and an examination at least every six months.

By Laura Minsk, DMD