By Dr Rosalind Ho BDS Spore MFGDP (UK)
Sometimes, a patient may have a gum boil in his or her gums over the roots of the tooth and it may or may not be painful. If there is a sinus tract, pus is discharged and the patient may not feel the pain. Otherwise, the pressure of the swelling can result in an intense ache.
This is an abscess and is caused by bacterial infection of the tooth or the gums.
Extra-orally, patient is checked for;
1 medical condition which makes him or her immunity compromised. He or she will need to see a doctor to rectify any underlying condition. For example, a diabetic patient may be more prone to abscesses and gum disease. Or patients on immuno-suppressive drugs, etc.
2 nutritional condition
3 Whether patient is febrile (running a temperature) and lymph nodes are tender and swollen (indicating spread of the infection)
Intra-orally, patient is checked for;
1 general oral health
2 pocketing (space between the tooth and the gums)
3 vitality of the tooth tested to see if it is a dead tooth
4 x-ray required to see the extent of the infection and suspected tooth.
5 Any ill-fitting denture that injures the gums causing infection
6 Consider the long term prognosis of whether it is worth saving the tooth.
If an intra-oral abscess arises, the patient may gargle with warm salt water and take some painkillers to reduce inflammation. Schedule an appointment to see a dentist immediately to find out the cause and treat the infection. The infection can spread to other teeth as well as systemically.
The dentist usually would prescribe antibiotics as well and may have to prick and drain the pus for faster resolution. Then the dentist will determine the cause and treat the gums and the tooth for the infection.
A common gum abscess occurs at the gum level and it is often due to plaque or food trap, in which case, scaling, and polishing will solve the problem. Oral hygiene instructions should be given including flossing.
Root canal treatment is necessary if it is due to a dead tooth where the infection has tracked through the gums and present as a boil. If it breaks spontaneously, usually the pain subsides, but the boil remains with a fistula or tract and reinfection can occur. If the prognosis is poor, it is better to extract after the infection is controlled.
If the abscess is due to a very deep gum pocket, deep gum cleaning (curettage) and root planing are required and assessed for long term prognosis. Gum surgery may be necessary to reduce the depth of the pocket and repair the bone damage.
General Instructions for good oral health
1 Regular check-ups at the dentist
2 Correct tooth brushing technique including flossing, twice a day.
3 Reduce sugary drinks and food.
4 Avoid tobacco use
5 Make sure dentures are well-fitted and does not traumatize the gums
Gum abscess can arise in the tissues surrounding wisdom teeth that are not fully erupted, a condition called pericoronitis. This is due to plaque trapped under the gum flap. After the inflammation is controlled, it is best to have the wisdom tooth removed.
An abscess that is not treated can sometimes track and appear as swelling with or without discharge on the outer skin. The origin of the source must be found. Oral malignancy is rare but never excluded.
Gum boils are very common and soft tissues in the mouth are vulnerable. Good oral health care can prevent painful episodes and unnecessary loss of teeth.