DISEASES OF THE PERIODONTAL TISSUES

Most periodontal diseases result in the gradual recession of the tissues of the periodontium. If the disease process is not stopped, it may progress to the harder, bony tissues of the alveolar ridge and lead to the loss of teeth.

MARGINAL GINGIVITIS

Gingivitis is an inflammation of the gingival tissue. Marginal gingivitis is a relatively mild inflammation of the borders of the gingival tissue. Sometimes, the inflammation is localized; it may exist around one, two, or a group of teeth. If the condition is generalized, then it will exist around all the teeth. The most frequent cause of marginal gingivitis is the presence of bacterial plaque buildup due to lack of adequate oral hygiene.

Symptoms

A patient with acute gingivitis may complain of the following:

Sore or swollen gums

Bleeding gums

Signs

Upon examination for gingivitis, you may observe:

A painful reaction or gingival bleeding when finger pressure is applied

Red, swollen gingiva with a loss of stippling

Heavy plaque and calculus deposits in the affected area

Treatment

To treat marginal gingivitis, include the following in the emergency treatment plan:

Perform the emergency treatment guidelines.

Give the patient oral hygiene instructions; refer to Dental Technician, Volume 2, NAVEDTRA 12573, chapter 3, "Preventive Dentistry."

Have the patient rinse with a warm saline solution.

Gently scale the teeth to remove soft debris and any obvious supragingival calculus.

NECROTIZING ULCERATIVE GINGIVITIS

Necrotizing ulcerative gingivitis (NUG) is a severe infection of the gingival tissue, commonly referred to as trenchmouth. It may result from untreated marginal gingivitis, poor dietary habits, smoking or alcohol consumption, a rundown physical condition of the patient, or a combination of these factors.

Symptoms

A patient may present the following symptoms when NUG is present:

The same symptoms as that of marginal gingivitis

A bad taste in the mouth

Pain when eating or brushing

Excessive bleeding

Signs

Upon examination for acute gingivitis, you may observe the following signs of NUG:

Same as those of marginal gingivitis, but more severe.

Heavy plaque and calculus deposits.

Ulceration and cratering of the interdental papillae. Frequently, so much of the papillae is lost that the triangular area between the crowns of the teeth present a "punched out" appearance.

A gray-white membrane covering the gingiva.

A foul odor from the oral cavity.

Pus oozing from the gingiva.

Areas of gingival recession.

Elevated temperature.

Treatment

Perform the emergency treatment guidelines. If the patient has an elevated temperature (101 or above), the dentist should treat the patient. If you are authorized to treat the patient, the treatment plan will be the same as for marginal gingivitis.

PERIODONTITIS

Periodontitis is an inflammation of the gingiva that involves the crest of the alveolar bone and the periodontal ligament above the alveolar crest. It usually results from untreated marginal gingivitis. It is marked by the gradual loss of attachment of the periodontal tissues. Periodontitis may affect the entire dentition or only localized areas.

Symptoms

A patient may present some of the following symptoms if periodontitis is suspected:

A "deep, gnawing pain" in the affected area

Itching of the "gums"

Sensitivity to heat and cold

Bleeding "gums"

Food sticking between the teeth

Loose or elongated teeth

A toothache with the absence of caries

An uneven bite

Increased spacing between the anterior teeth

Signs

Upon examination you may observe the following sign of periodontitis:

Heavy plaque and calculus deposits

Gingival inflammation, bleeding, or discoloration (bluish-red)

Localized or generalized gingival bleeding

Ulcerated or cratered papilla

Tooth mobility

Treatment

Perform the emergency treatment guidelines. The emergency treatment plan will be the same as for marginal gingivitis and NUG.