5-15
- Administer antibiotic regimen. (See Dental Antibiotics later in this chapter.)
- Evacuate for consultant care.
NOTES: A partially avulsed tooth that is repositioned is usually permanently retained. A completely avulsed
tooth may be permanently retained if replaced in the socket with minimal handling in less than one hour.
When the replacement time exceeds one hour, the long-term retention rate drops and root resorption usually
occurs.
- PERIODONTAL ABSCESS - this acute suppurative process occurs in the periodontal tissues
alongside the root of a tooth and involves the alveolar bone, periodontal ligament and gingival
tissues. It most often is due to irritation from a foreign body, subgingival calculus (tartar, hard calcium
deposits on the teeth) or local trauma, and subsequent bacterial invasion of the periodontal tissues.
Subjective: Symptoms
Deep, throbbing, well-localized pain of the soft tissues surrounding the tooth; tooth feels elevated in its socket.
Objective: Signs
Redness, tenderness and swelling of the surrounding gingiva; sensitivity to percussion; mobile tooth; cervical
lymphadenopathy; fever; purulent exudate.
Assessment:
Differential Diagnosis - chronic apical abscess, necrotic pulp
Plan:
- Carefully probe and drain the gingival crevice and locate any foreign body.
- Spread the tissues gently and irrigate with warm water to remove remaining pus or debris from the abscess
area. - Remove any foreign bodies.
- Instruct the patient to use a hot saline mouth rinse hourly.
- Administer antibiotic regimen if systemic conditions are present (elevated temperature, general malaise).
- ACUTE NECROTIZING ULCERATIVE GINGIVITIS (Vincent’s infection, trench mouth).
Necrotic gingival lesions result from ordinarily harmless surface parasites exposed to an altered environment.
Virulent fusospirochetal organisms have been implicated, but the precise cause has not been proven. General
health, diet, fatigue, stress, and lack of oral hygiene are the most important precipitating factors. This disease is
not considered to be transmissible. Untreated lesions are destructive with progressive involvement of the gingival
tissues and underlying structures.
Subjective: Symptoms
Constant gnawing pain, marked gingival sensitivity and hemorrhage, fetid odor, foul metallic taste, general
malaise and anorexia.
Objective: Signs
Necrosis, ulcers with pseudomembrane cover, cervical lymphadenitis, fever. Advanced cases involve gingival
tissues and underlying structures.
Assessment:
Differential Diagnosis - blood dyscrasias or vitamin deficiencies (scurvy), HIV-related periodontitis.
Plan:
Establish good oral hygiene in acute cases by following these steps:
- First day: Wearing surgical or exam gloves if possible, swab the teeth and gingiva thoroughly with a 1:1
aqueous solution of 3% hydrogen peroxide on a cotton-tipped applicator twice. Instruct the patient to rinse