HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIES■ Diffuse red, painful, and inflamed gingiva with various degrees of ery-
thema and ulcerations (typically peri-incisors and molars)
■ Necrotic tissue in and around the gingival crest
■ Metallic taste
■ Foul breath/halitosis
■ Grey pseudomembrane along the gingiva; may expose bleeding ulcera-
tions when removed
■ Loss of gingival tissue (especially interdental papillae)
■ May be accompanied by fever, malaise, regional lymphadenopathy
TREATMENT
■ Irrigate with warm saline.
■ Analgesics (topical and PO)
■ Antibiotics indicated include penicillin, metronidazole (Flagyl), clindamycin.
Considerswish and spit rinses such as hydrogen peroxide or chlorhexidine
solution.
■ Dental referral for follow-up debridement
■ Admit patients with extensive disease, systemic symptoms, immunocom-
promised, or requiring IV treatment.
COMPLICATIONS
■ Vincent’s angina: Spread to pharynx and tonsils
■ Spontaneous bleeding gums, sloughing of the gingiva
Aphthous Stomatitis
■ Chronic mucosal inflammatory/ulcerative disease of uncertain etiology
(see Figure 14.26)
■ Linked to cell mediated immune response, viral, genetic predisposition,
stress, trauma, and malnutrition (including celiac sprue)
FIGURE 14.26. Aphthous stomatitis.(See also color insert.)
(Reproduced, with permission, from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color
Atlas & Synopsis of Clinical Dermatology, 5th ed. New York: McGraw-Hill, 2005:1017.)