Gum Disease 101Gum Disease 101Diagnosis and TreatmentDiagnosis and Treatment

By By

LT SHELLBACKLT SHELLBACK

20072007

Gingivitis - MarginalGingivitis - Marginal THE SYMPTOMSTHE SYMPTOMS

– A. “my gums are sore A. “my gums are sore or swollen”or swollen”

– B. the gums bleedB. the gums bleed

THE SIGNSTHE SIGNS– A. painful reaction to A. painful reaction to

gingival bleedinggingival bleeding– B. red swollen gingiva B. red swollen gingiva

with loss of with loss of stipplingstippling– C. Heavy plaque and C. Heavy plaque and

calculuscalculus

Treatment of Marginal GingivitisTreatment of Marginal Gingivitis

Oral hygiene Oral hygiene instructioninstruction

Warm saline rinseWarm saline rinse Scale teeth to Scale teeth to

remove debrisremove debris

Necrotizing Ulcerative GingivitisNecrotizing Ulcerative Gingivitis SymptomsSymptoms

– A. Same as marginal gingivitisA. Same as marginal gingivitis– B. bad taste in mouthB. bad taste in mouth– C. Pain when eating/brushingC. Pain when eating/brushing– D. Excessive bleedingD. Excessive bleeding

SignsSigns– A. Same as marginal gingivitisA. Same as marginal gingivitis– B. Ulceration of interdental B. Ulceration of interdental

papillapapilla– C. Gray membrane covering C. Gray membrane covering

gingivagingiva– D. Foul breath or Fetid odorD. Foul breath or Fetid odor– E. Pus from the gingiva or E. Pus from the gingiva or

gingival recessiongingival recession– F. Elevated Temperature F. Elevated Temperature

TreatmentTreatment

If temperature over If temperature over 101 degrees refer 101 degrees refer immediately to immediately to dentist (so he has dentist (so he has to smell the to smell the patients breath)patients breath)

IF non-febrile treat IF non-febrile treat the same as the same as marginal gingivitis marginal gingivitis

PeriodontitisPeriodontitis SymptomsSymptoms

– A. Gnawing painA. Gnawing pain– B. Itching gumsB. Itching gums– C. Hot or Cold C. Hot or Cold

sensitivity or bothsensitivity or both– D. Gums bleedD. Gums bleed– E. Food sticks between E. Food sticks between

teethteeth– F. Loose or long teethF. Loose or long teeth– G. Teeth ache or G. Teeth ache or

uneven biteuneven bite– H. Increased spacing of H. Increased spacing of

anterior teethanterior teeth

SignsSigns

Heavy plaque and Heavy plaque and calculuscalculus

Gingival Gingival inflammation & inflammation & bleedingbleeding

Mobile TeethMobile Teeth Cratered papillaCratered papilla

Treatment of PeriodontitisTreatment of Periodontitis

Rinse and remove Rinse and remove debrisdebris

Return the second dayReturn the second day

Refer to the dentistRefer to the dentist

Periodontal AbscessPeriodontal Abscess SymptomsSymptoms - A. Throbbing Pain- A. Throbbing Pain

- B. Pain to chewing & - B. Pain to chewing & lying downlying down- C. Bad Taste (means - C. Bad Taste (means pus)pus)- D. Gumboil or bump- D. Gumboil or bump- E. “Tooth feels - E. “Tooth feels longer”longer”- F. Malaise Tender - F. Malaise Tender lymph nodeslymph nodes

SignsSigns

Pain to pressurePain to pressure GumboilGumboil Facial Swelling Facial Swelling Mobile ToothMobile Tooth Febrile (elevated Febrile (elevated

temp)temp) Enlarged Lymph Enlarged Lymph

nodesnodes

TreatmentTreatment

1.Establish Drainage with a Scaler or explorer

2. Warm Saline Rinse

PeriocornitisPeriocornitis

SymptomsSymptoms

- A. Pain when - A. Pain when chewingchewing

- B. Bad Taste- B. Bad Taste

- C. Difficulty - C. Difficulty opening mouth opening mouth (Trismus) (Trismus)

- D. Swelling in the - D. Swelling in the neckneck

- E. Fever- E. Fever

SignsSigns

Partially erupted Partially erupted Red inflamed Red inflamed

tissuetissue Painful with Painful with

pressurepressure Swelling in the Swelling in the

cheekcheek Elevated TempElevated Temp

Tx of PeCorTx of PeCor

Irrigate with salineIrrigate with saline Use ultrasonic Use ultrasonic Rinse with salt Rinse with salt

water every 2 water every 2 hourshours

Refer to dentist if Refer to dentist if febrilefebrile

Post Surgical Complications and Post Surgical Complications and TraumaTrauma

Are you bored yet????Are you bored yet???? Does the LT need to shut up???Does the LT need to shut up???

Post Extraction HemorrhagePost Extraction Hemorrhage

SymptomsSymptoms– A. bleeding that won’t A. bleeding that won’t

stop after EXTstop after EXT– B. Weakness in B. Weakness in

conjunction with blood conjunction with blood lossloss

– C. Blood on pillowC. Blood on pillow

SignsSigns– A. Blood oozing in the A. Blood oozing in the

mouthmouth

Treatment of Post OP HemorrhageTreatment of Post OP Hemorrhage

Contact DentistContact Dentist Check Vital SignsCheck Vital Signs Pack moistened Pack moistened

sterile gauze and sterile gauze and have patient bite have patient bite downdown

POST Extraction Alveolar Osteitis POST Extraction Alveolar Osteitis (aka Dry socket) (aka Dry socket)

SymptomsSymptoms– A. Severe Constant A. Severe Constant

pain/achepain/ache– B. Loss of clotB. Loss of clot

SignsSigns– A. Absence of blood clotA. Absence of blood clot– B. Food in socket siteB. Food in socket site– C. Alveolar bone is C. Alveolar bone is

visiblevisible– D. Foul OdorD. Foul Odor– E. FebrileE. Febrile

Treatment of Alveolar OsteitisTreatment of Alveolar Osteitis

Rinse with warm Rinse with warm salinesaline

Loosely pack with Loosely pack with iodoform gauzeiodoform gauze

Patient RTC the Patient RTC the next day to remove next day to remove dressingdressing

Avulsed TeethAvulsed Teeth

If dentist instructs If dentist instructs you toyou to

Need radiographs Need radiographs (not on test)(not on test)

Time is imperative Time is imperative to re-implantationto re-implantation

FX Mandible or MaxillaFX Mandible or Maxilla

SymptomsSymptoms– 1. difficulty 1. difficulty

breathingbreathing– 2. pain when moved2. pain when moved– 3. inability to open3. inability to open– 4. bleeding gums4. bleeding gums– 5. teeth don’t touch5. teeth don’t touch– 6. lower lip is 6. lower lip is

numbernumber

Signs of FXSigns of FX

1. Facial Swelling1. Facial Swelling 2. Abnormal 2. Abnormal

OcclusionOcclusion 3. FX bone (x-ray)3. FX bone (x-ray) 4. Abnormal 4. Abnormal

movementmovement

Treatment - palliativeTreatment - palliative

Call the dentistCall the dentist Immobilize with Immobilize with

bandagebandage Apply IceApply Ice