As with all periodontal conditions the most effective and important thing for patients to do is to regularly attend the dentist for examinations, follow treatment planned including regular scaling and polishing and maintain good oral hygiene at home.
Gingival hyperplasia
Gingival hyperplasia is a condition which usually comes about through the use of certain drug treatments such as Phenytoin which can be taken for epilepsy, and Nifedipine which can be taken for high blood pressure and angina pectoris. This condition is where the gingivae become severely enlarged.
The treatment for this condition is called a gingivectomy, this is the removal of gum tissue with a gingivectomy knife, a scalpel and blade, or by use of an electrosurgery unit, which cuts away the required section of gum and coagulates the blood at the same time.
Once the area of gum concerned has been cut away it is removed with tissue tweezers and a special periodontal pack, which is usually zinc oxide and eugenol based, such as Coe Pak, is placed in order to promote healing and to give protection to the raw gum tissue.
Gums heal extremely quickly as a rule, so a gingivectomy is carried out under local anaesthetic; the procedure is reasonably quick and is very simple.
Treatments such as gingivoplasty, operculectomy, and crown lengthening are procedures that are all a type of gingivectomy but are carried out in different circumstances; they generally do not require the use of a periodontal dressing post treatment.
- Gingivoplasty – re-contouring of healthy gum tissue to either aid in cleaning or to achieve better aesthetics
- Operculectomy – the removal of a gum flap which covers a partially erupted wisdom tooth, where pericoronitis repeatedly occurs and where other treatments such as in- surgery irrigation of the operculum, prescription of antibiotics, and ineffective oral hygiene home care, prove ineffective. Pericoronitis is a condition where the flap of gum over a partially erupted wisdom tooth regularly becomes infected and painful due to difficult cleaning or due to an opposing tooth biting down on to the gum tissue.
- Crown lengthening – the removal of gum tissue in order to expose more root surface of a tooth which is to receive a crown but would otherwise have insufficient retention.
Acute Herpetic Gingivitis
This periodontal condition most often affects infants. It is caused by the same type of virus that causes cold sores – herpes simplex, and can be extremely uncomfortable. Lots of tiny ulcers and general acute inflammation are the main effects of this condition, but thankfully it usually only lasts for a short period of time. This condition does not require any treatment as it will resolve by itself, but it can reoccur. When the condition is not active, the virus lies dormant and when the patient is feeling run down it can reappear.
Acute Necrotising Ulcerative Gingivitis (ANUG)
This is a particularly painful type of acute gingivitis, and may only appear in some areas of the mouth, rather than the whole of the oral cavity, it usually occurs where chronic gingivitis is already present. There are all the signs of chronic gingivitis, red inflamed gums, halitosis, etc, but there is also a layer of grey or yellow looking membrane present where painful ulcers can be found, this is where the gingival margin is destroyed by the bacteria present.
There are various treatments available for this condition, they include;
- Use of a chlorhexidine mouthwash
- Prescription for antibiotics
- Scaling and polishing once the condition has disappeared
Acute Lateral Periodontal Abscess
This occurs in patients who have periodontitis, where true pockets are present. As true pockets are deep and destruction of periodontal condition is occurring in periodontitis, sometimes pus can form within these pockets. Most of the time the pus can be drained through the top of the pocket – at the gingival crevice, however if this is not possible the pus will sit at the base of the pocket on the side of a vital tooth’s root and an abscess will form.
Treatment for this condition depends on the individual circumstances, treatment includes;
- Sub-gingival scaling of the affected area
- Local administration of antibiotic
- Drainage of pus in surgery
- Sometimes extraction is necessary
