Gingivitis: Diagnosis and Treatment
The article I chose discussed the diagnosis and treatment of three different gingival diseases and the importance of the emergency room staff being familiar with the diseases. This investigation led to the discovery that there are several conditions referred to as gingivitis: gingivitis, necrotizing ulcerative gingivitis (NUG), and gingival abscesses.
Description of Diseases
Gingivitis: A response to an accumulation of oral bacteria in the gingival sulcus of the mouth.
Necrotising Ulcerative Gingivitis: Often presents suddenly after episodes of debilitating disease, stress, poor nutrition, smoking, or changes of lifestyle. There may also be a bacterial element to NUG.
Gingival Abscess: Caused by foreign substances that have been forced into the gingival tissues, triggering an inflammatory response.
Distinguishing Diagnostic Factors
Gingivitis: Inflammation, redness, swelling, and bleeding on gentle provocation of the gingival sulcus.
Necrotising Ulcerative Gingivitis (NUG): For a diagnosis of NUG to be made, the following must be present in the mouth: Painful lesions with rapid onset, ulceration of the interdental papillae, and spontaneously or readily bleeding gingival ulcers.
Gingival Abscess: Acute and painful lesions with red, smooth, and shiny surfaces. These will typically have expanded over 24-48 hours. They are usually confined to the marginal gingival tissues, often at previously unaffected areas.
Etiology of Diseases
Gingivitis, NUG, and Gingival Abscess:
local factors- Microorganisms, food impaction, faulty or restorative orthodontic appliances, breathing through mouth, tooth malposition, chemical or drug application.
Systemic factors- Nutritional disturbances, pregnancy, diabetes, and other conditions that cause endocrine dysfunction.
Classification of the Disease
Gingival index
0 No inflammation Gingival tissue is normal
1 Mild inflammation There are small changes to the colour and
texture of the gingival tissue, but there is
no bleeding on palpation or probing
2 Moderate inflammation There is some redness, oedema and glazing
of the gingival tissue, which bleeds on
palpation or probing
3 Severe inflammation There is marked redness, oedema and
ulceration of the gingival tissue, which tends
to bleed spontaneously
Prevalence Of the Disease
In this article it is talking about the prevalence in the Emergency room. They estimate that 0.3-0.5 per cent of new attendances to the Emergency room are for dental problems.
Treatment Recommendations or Corrective Procedures
One common aspect to all three conditions is that they can be painful so any treatment strategy should include pain relief. Non-steroidal anti-inflammatory drugs (NSAIDs) can provide effective pain relief, and can be combined with paracetamol to relieve breakthrough pain. Patients who cannot take NSAIDs can use paracetamol alone or in combination with codeine. However, strategies for pain management should follow local guidelines. The final stage of treatment is ensuring that the mouth is kept clean with saline rinses or mouthwashes containing chlorhexidine to prevent a recurrence of each for of gingivitis.
References
Summers, A. (2009). Gingivitis: diagnosis and treatment. Emergency Nurse, 17(1), 18-20.
Description of Diseases
Gingivitis: A response to an accumulation of oral bacteria in the gingival sulcus of the mouth.
Necrotising Ulcerative Gingivitis: Often presents suddenly after episodes of debilitating disease, stress, poor nutrition, smoking, or changes of lifestyle. There may also be a bacterial element to NUG.
Gingival Abscess: Caused by foreign substances that have been forced into the gingival tissues, triggering an inflammatory response.
Distinguishing Diagnostic Factors
Gingivitis: Inflammation, redness, swelling, and bleeding on gentle provocation of the gingival sulcus.
Necrotising Ulcerative Gingivitis (NUG): For a diagnosis of NUG to be made, the following must be present in the mouth: Painful lesions with rapid onset, ulceration of the interdental papillae, and spontaneously or readily bleeding gingival ulcers.
Gingival Abscess: Acute and painful lesions with red, smooth, and shiny surfaces. These will typically have expanded over 24-48 hours. They are usually confined to the marginal gingival tissues, often at previously unaffected areas.
Etiology of Diseases
Gingivitis, NUG, and Gingival Abscess:
local factors- Microorganisms, food impaction, faulty or restorative orthodontic appliances, breathing through mouth, tooth malposition, chemical or drug application.
Systemic factors- Nutritional disturbances, pregnancy, diabetes, and other conditions that cause endocrine dysfunction.
Classification of the Disease
Gingival index
0 No inflammation Gingival tissue is normal
1 Mild inflammation There are small changes to the colour and
texture of the gingival tissue, but there is
no bleeding on palpation or probing
2 Moderate inflammation There is some redness, oedema and glazing
of the gingival tissue, which bleeds on
palpation or probing
3 Severe inflammation There is marked redness, oedema and
ulceration of the gingival tissue, which tends
to bleed spontaneously
Prevalence Of the Disease
In this article it is talking about the prevalence in the Emergency room. They estimate that 0.3-0.5 per cent of new attendances to the Emergency room are for dental problems.
Treatment Recommendations or Corrective Procedures
One common aspect to all three conditions is that they can be painful so any treatment strategy should include pain relief. Non-steroidal anti-inflammatory drugs (NSAIDs) can provide effective pain relief, and can be combined with paracetamol to relieve breakthrough pain. Patients who cannot take NSAIDs can use paracetamol alone or in combination with codeine. However, strategies for pain management should follow local guidelines. The final stage of treatment is ensuring that the mouth is kept clean with saline rinses or mouthwashes containing chlorhexidine to prevent a recurrence of each for of gingivitis.
References
Summers, A. (2009). Gingivitis: diagnosis and treatment. Emergency Nurse, 17(1), 18-20.