P

periodontal disease Inflammatory and some-
times infectious damage to the gums. Periodontal
disease causes gum tissue to recede from the
TEETH, which allows teeth to loosen. It also exposes
the less protected area of the tooth to BACTERIA
that cause tooth decay, resulting in DENTAL CARIES
(cavities) and potential INFECTIONsuch as ABSCESS
of the root canal. Periodontal disease is the leading
cause of tooth loss in adults. Dental care providers
estimate that up to 60 percent of American adults
have some degree of periodontal disease.
Symptoms of periodontal disease include

• painless bleeding, especially when brushing the
  teeth


• swollen, shiny, or red gums


• gaps between the gums and the teeth


• loose teeth


• HALITOSIS(bad breath) that does not improve
  with brushing or mouthwash

Dentists provide diagnosis and treatment for
periodontal disease. Appropriate ORAL HYGIENEcan
prevent most periodontal disease; identifying peri-
odontal disease early allows opportunity for thera-
peutic interventions to thwart permanent damage.
Some health experts believe there are connections
between the body’s inflammatory response, peri-
odontal disease, and other health conditions such
as ATHEROSCLEROSIS and CORONARY ARTERY DISEASE
(CAD).
See also GINGIVITIS; INFLAMMATION.

peritonsillar abscess A serious and painful
INFECTIONof the tissues around the tonsils in the
back of the THROAT. Unlike TONSILLITIS, which is pri-

marily an infection among children, peritonsillar

ABSCESSis most common among adults in early

midlife. Doctors are uncertain what causes a peri-

tonsillar abscess to develop, though it will often

follow another infection such as tonsillitis, PHARYN-

GITISor mononucleosis.

Symptoms emerge suddenly. They include

• severe and usually one-sided PAINin the throat


• pain in the EARon the opposite side from the
  abscess with swallowing


• FEVER
  
  
  • a whispery, hoarse voice
  
  
  • neck stiffness and sometimes swelling on the
    front of the neck
  
  
  • difficulty swallowing
  
  
  • inability to fully open the mouth (called tris-
    mus)
  
  
  
  

Symptoms and physical examination typically

make the diagnosis, though the doctor may per-

form a laryngoscopy to more closely examine the

throat. After swabbing the peritonsillar area for

culture, treatment with intravenous ANTIBIOTIC

MEDICATIONSbegins. The person remains hospital-

ized until the swelling goes down and the pain

abates, at which point antibiotic therapy shifts to

oral doses for the remainder of treatment at home.

When the abscess is large or has the potential to

interfere with BREATHING, the doctor may choose to

surgically open and drain it (under anesthesia).

This provides dramatic relief. Most people recover

fully and without complications in about two

weeks.

See also ENDOSCOPY; EPIGLOTTITIS; MONONUCLEOSIS,

INFECTIOUS.

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