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Mouth Pain with Red Gums AMY M Photo Quiz Mouth Pain with Red Gums AMY M. ZACK, MD, FAAFP; MIRCEA OLTEANU, DDS; and IYABODE ADEBAMBO, MD MetroHealth Medical Center, Cleveland, Ohio The editors of AFP wel- On physical examination there was diffuse come submissions for erythema of the gums with mild edema and Photo Quiz. Guidelines for preparing and sub- tenderness. The patient had thick deposits mitting a Photo Quiz at the gum line that could not be wiped off. manuscript can be found There were areas of erythema, gum recession, in the Authors’ Guide at and increased movement of the teeth. There http://www.aafp.org/ afp/photoquizinfo. To be was pain when moving the teeth. There was no considered for publication, purulence, facial edema, or lymphadenopathy. submissions must meet Figure. these guidelines. E-mail Question submissions to afpphoto@ aafp.org. A 74-year-old man presented with pain in Based on the patient’s history and physical his mouth. The pain had been present for examination findings, which one of the fol- This series is coordinated by John E. Delzell, Jr., MD, a few months but had recently increased in lowing is the most likely diagnosis? intensity. He had not had recent dental work MSPH, Assistant Medical ❏ A. Dental abscess. Editor. and did not see a dentist regularly. He did not ❏ B. Dental caries. have a history of oral, head, or neck surgery. A collection of Photo Quiz ❏ C. Periodontal disease. published in AFP is avail- He did not have fever, chills, swelling of the ❏ D. Plaque gingivitis. able at http://www.aafp. face or neck, or discharge or drainage from org/afp/photoquiz. the area. See the following page for discussion. Previously published Photo Quizzes are now featured in a mobile app. Get more information at http:// www.aafp.org/afp/apps. NovemberDownloaded 1, from 2014 the ◆ American Volume Family90, Number Physician 9 website at www.aafp.org/afp.www.aafp.org/afp Copyright © 2014 American Academy of FamilyAmerican Physicians. Family For the Physician private, noncom 653- mercial use of one individual user of the website. All other rights reserved. Contact [email protected] for copyright questions and/or permission requests. Photo Quiz Early treatment of periodontal dis- Summary Table ease helps prevent tooth loss and includes removal of calculi above and below the gum Condition Characteristics line. There is no indication for antibiotics. Education and prevention include encour- Dental Localized infection; pain, inflammation, purulent aging patients to brush after meals and floss abscess drainage, lymphadenopathy, and facial edema; possible systemic symptoms, such as fever, chills, and malaise daily. Later treatment includes more invasive Dental caries Destruction of enamel and subsequently tooth and surgical approaches. structure; dark spots, localized pain, hot or cold Dental abscesses are localized infections sensitivity, and pain with eating resulting from the introduction of bacteria Periodontal Chronic gingival disease; pocket formation and gingival into a gingival pocket or as a progression disease recession; characterized by the presence of calculus of decay into the pulp. They cause pain, and tooth destruction inflammation, purulent drainage, lymph- Plaque Reversible gingival erythema and inflammation; soft adenopathy, and facial edema. Systemic gingivitis plaque formation that is easily wiped off; no calculus and pocket formation or tooth destruction symptoms, including fever, chills, and mal- aise, may also occur. Dental caries or cavities are the result of decay in the enamel that subsequently Discussion causes tooth decay. It is identifiable as dark The answer is C: periodontal disease. Peri- spots of tooth destruction that occur at any odontal disease is the loss of gum attachment location on the tooth. This causes localized at the base of the tooth, creating at least one pain, hot or cold sensitivity, and pain with pocket.1 Periodontal disease leads to a cal- eating. culus comprised of bacteria, acid, food, and Plaque gingivitis is a reversible condi- saliva located above and below the gum line tion defined by gingival erythema and soft that cannot be wiped off. This calculus cre- plaque deposits that are easily wiped off. It ates pockets along the dentition, providing is distinguishable from periodontal disease space for infection, inflammation, and break- because there is no calculus and pocket for- down of the bone and tissues that support mation or tooth destruction. Gingival irrita- the teeth. This causes loose teeth, erythema, tion may be related to poor dental hygiene edema, bleeding, and pain. and is common in pregnancy and in persons Nearly 50% of adults in the United States with diabetes. have periodontitis, usually with pocket for- Address correspondence to Amy M. Zack, MD, FAAFP, mation around multiple teeth. Men, Mexi- at [email protected]. Reprints are not available can Americans, and smokers are at highest from the authors. risk. The incidence of periodontal disease is Author disclosure: No relevant financial affiliations. inversely proportional to income and educa- 2 tion level. REFERENCES Adolescents are prone to Actinobacillus 1. National Institute of Dental and Craniofacial Research. actinomycetemcomitans infection that can Periodontal disease in adults (age 20 to 64). http:// rapidly and aggressively cause periodontitis.3 www.nidcr.nih.gov/datastatistics/finddatabytopic/ Pregnancy-related gingivitis can progress to gumdisease/periodontaldiseaseadults20to64.htm. Accessed March 11, 2013. more severe disease. Some diseases are associ- 2. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ; ated with higher rates of periodontal disease, CDC Periodontal Disease Surveillance Workgroup. Prev- including diabetes mellitus, human immuno- alence of periodontitis in adults in the United States: deficiency virus infection, and autoimmune 2009-2010. J Dent Res. 2012;91(10):914-920. 3. American Academy of Periodontology; Research, Sci- disease. Medications such as bisphosphonates, ence, and Therapy Committee. Periodontal Diseases of phenytoin (Dilantin), cyclosporine (Sandim- Children and Adolescents. Chicago, Ill.: The Academy; mune), and nifedipine (Procardia) have been 1992. 4. Gum disease in-depth report. The New York Times. linked with gingival and jaw changes that http://health.nytimes.com/health/guides/disease/ contribute to periodontal disease.4 periodontitis/print.html. Accessed March 11, 2013. ■ 654 American Family Physician www.aafp.org/afp Volume 90, Number 9 ◆ November 1, 2014.
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