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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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Periodontics: Uses of Periodontic Dental Lasers

Since their introduction in the 1960's, laser use in medicine and dentistry has increased steadily, and it's been no different in Periodontics. The CO2 and the Nd:YAG lasers have both received Food and Drug Administration (FDA) approval for soft tissue surgery and are the most commonly used lasers in dentistry. A dental laser work by delivering concentrated beams of light strong enough to cut through tissue.

Pros & Cons of Dental Lasers

The popularity of lasers results from claims that dental laser gum treatment is painless. Although the FDA has not permitted the manufacturer of any laser to make that claim, the general experience described by patients is that there is less pain and swelling after laser treatment compared to conventional oral surgery. Local anesthesia for pain control is still required during laser surgery.

Another advantage of the laser is that it causes less bleeding in the area of surgery than traditional oral surgery techniques. This is especially helpful in the oral cavity, which has an abundant blood supply. The laser decreases bleeding by sealing the blood vessels at the surgical wound. On the flip side, this can delay healing and create a less stable wound.

Application of Lasers in Periodontal Treatment

The application of lasers in periodontal treatment is restricted to the removal of gum tissue to reduce pocket depth, or for some minor periodontal plastic surgery procedures. These surgeries can be easily performed with traditional instruments without the additional high cost of dental laser treatment.

More recently, lasers have been evaluated for use in scaling and root planing. But in a research study recently published in the Journal of Periodontology, laser therapy appeared to be less effective than traditional scaling and root planing treatment. In fact, research has not conclusively shown that laser therapy is effective in removing the tartar that has accumulated under the gum line and can actually damage the surfaces of teeth and the bone. This damage could delay healing and the ability of the gum tissue to reattach to the root surface.

For all these reasons, the American Academy of Periodontology is concerned about misleading claims regarding the use of lasers in periodontics. It is important to remember that laser treatment in periodontics is limited to soft tissue (gum) for periodontal surgery and that the laser beam should not touch the tooth or bone. Anesthesia is required during dental laser treatment, and dental laser treatment may be more expensive than traditional surgical procedures.

By Laura Minsk, DMD