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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Periodontitis, The Leading Cause of Gum Disease
According to information from the American Dental Association, three out of four Americans over age 35 have some form of periodontal disease, the major cause of tooth loss and bad breath (halitosis) in adults. Gingivitis is the mildest form of periodontal disease that, if left untreated, can progress to periodontitis, the loss of bone and tissues that support the tooth.
Periodontal disease has three stages, categorized by the extent of bone loss: mild moderate, and advanced. If only one or a few teeth are effected, it is localized. If all the teeth are involved, it is generalized.
Bacteria that accumulate at and below the gum line cause periodontitis. The bacteria release toxic substances that trigger the breakdown of the gum and bone. The body responds with an inflammatory response in which it essentially turns on itself and destructs the bone and tissues around the teeth. This is the body's way of warding off infectious agents.
When this happens the gum separates from the teeth, forming a gap called a periodontal pocket. If left untreated, periodontitis can lead not only to tooth loss but can also aggravate systemic illnesses. The signs of periodontitis may include:
- Bleeding gums when brushing or flossing
- Red, tender or swollen gums
- Bad breath (halitosis) or bad taste
- Receding gums (gums that have pulled away from the teeth)
- Loose teeth
- Teeth that have migrated from their original positions
- Tooth loss
Very often, however, people are not aware that they should see a periodontics professional because gum disease can progress without pain. It is possible to not exhibit warning signs and still have periodontitis. That is why it is very important to have routine periodontal screenings so that the early signs of the disease can be detected and treated before it becomes a major problem.
Periodontal Treatment
Periodontitis is treated in three phases. The first phase involves stopping the disease activity and progression of bone loss. The bacterial deposits (plaque and tartar) that formed above and underneath the gums need to be removed and the root surfaces of the teeth smoothed to enhance healing and deter future plaque retention.
This periodontal treatment is called scaling and root planing. During this phase, a dentist will review the patient's oral hygiene techniques, and give them advice on how to modify certain risk factors associated with periodontal disease.
If the periodontal disease is more advanced, surgical treatment may be needed. The purpose of this phase of periodontal treatment is to create an environment that is more amenable to health and, if possible, bring back some of the bone that was lost to the disease. In some forms of periodontitis, antibiotic treatment may be used. If this is the case, a bacterial culture may be required to test for harmful bacteria and to establish what antibiotics they are susceptible to.
Periodontal disease is a chronic condition that, like many others, has to be closely monitored, even after active treatment.
The third (maintenance) phase is crucial to the success of any periodontal treatment. Daily brushing and flossing is essential in controlling ever-developing plaque and bad breath, as is periodic periodontal maintenance care with a professional scaling of the teeth. Periodontal status will be closely monitored, so that changes can be identified and treated as early as possible.
Everyone should be routinely screened for periodontitis. All dentists are qualified in detecting and treating the early stages of periodontitis, but if an individual suspects that they are at risk, or they know they have gingivitis, they may want to see a periodontist who has advanced training in the diagnosis and treatment of periodontal conditions.
By Laura Minsk, DMD