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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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Dental Procedure For Dental Recession

Dental recession is a displacement of the gum around the teeth that results in greater tooth exposure and a longer looking tooth. As the gum that protects the root surface of the tooth is lost, not only does it create an esthetic deformity, it makes the tooth more sensitive to changes in temperature (hot and cold), touch, and to proper oral hygiene techniques. The exposed root surfaces also are more susceptible to cavities. Causes of dental recession include:

• Periodontal disease: The bacteria that cause gingivitis can release toxins that injure the gum tissues and create gum recession. Once the gum is affected by gingivitis (see article "Gingivitis"), it is even more susceptible to further dental recession and bone loss. So if the gum is red, swollen, or bleeds when probed, it is more likely to continue receding. Eventually, there may not be enough healthy gum and bone left to protect the tooth and the tooth may need to be removed. If there is less than 2 mm of healthy gum in an area of recession, a dentist may recommend a gum graft to help prevent further receding gums and help protect the tooth.
• Trauma: Medium or hard bristle toothbrushes, brushing too hard, or brushing inappropriately can damage the teeth and the gums. It is very important to use a soft bristle toothbrush when cleaning the teeth, and to follow proper technique. Mechanical trauma to the gums also can be caused by improperly fitting dental restorations or dentures. Fillings that are rough or dentures that are loose or poorly designed can injure the gums and cause them to recede.

Gums also may recede as a result of orthodontic treatment or from manipulation during restorative procedures. To prevent this from occurring, a dentist may recommend gum grafting before orthodontics or restorative treatment.

Gum grafts are indicated if an individual has root sensitivity to touch or temperature changes, if new restorative work will be done in the area of the dental recession, if the roots are susceptible to cavities, or if an individual is having problems following proper plaque control procedures. In addition, gum grafts are cosmetic periodontal procedures that can be performed to enhance smiles if recession has created esthetic problems such as long teeth or exposed roots.

By Laura Minsk, DMD