HomeAnswersDentistrygingivitisWhat is the reason for gingival pain and swelling in the missed tooth region?

I have gingival swelling due to pressure from hard foods. Please help.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Bharat Joshi

Medically reviewed by

Dr. Vinodhini J.

Published At August 27, 2020
Reviewed AtAugust 27, 2020

Patient's Query

Hello doctor,

My gum besides the front tooth is swollen because that part of it has no tooth and hard food have been creating pressure against it. Currently, I am taking Augmentin. Should I visit a dentist? I do not think it is a tooth issue. Please help.

Answered by Dr. Bharat Joshi

Hello,

Welcome to icliniq.com.

First of all, thank you very much for The picture (attachment removed to protect patient identity).

You are right. This area is swollen because there is no adjacent tooth there. Secondly, you are having a course of Augmentin (Amoxicillin and Clavulanic acid). I recommend you to first complete the course first and then probably find the time (not an emergency) to visit the dentist so that this area could be filled with the tooth. Until then no worries.

The Probable causes

Lost tooth.

Investigations to be done

IOPA (intra oral periapical radiography) and RVG.

Differential diagnosis

Epulis fissuratum.

Probable diagnosis

Gingival enlargement due to missing tooth.

Treatment plan

Completion of course followed by prosthesis probably Fpd (fixed partial denture) or implants.

Preventive measures

Oral hygiene maintenance.

Regarding follow up

After completion of course if swelling increases or some more symptoms occur i.e. after seven days.

Patient's Query

Thank you doctor,

Yesterday, I went to see the dentist and he let me had an x-ray taken which indeed showed infection in that tooth. The dentist cleaned my gum and tooth and put some solution into my gum.

However, I think I may have cracked that tooth on the same day because I remembered biting on something while eating with a tick sound that led to severe pain in that tooth that led me to see the doctor. Before that there was no pain.

Nevertheless, the x-ray does not show any crack so I was puzzled. So I followed the dentist's prescription of 250 mg Moxilen and painkiller. I suspect that the antibiotics may not be strong enough. Today the pain in my tooth become more severe and I cannot bite on my food as this give me intense pain. The dentist also told me that infected tooth had root canal done to it before, though I cannot recall.

What is your suggestion now? Should I endure a few more days to see whether my condition may improve, then return to see the dentist?

Answered by Dr. Bharat Joshi

Hello,

Welcome back to icliniq.com.

You are already having antibiotic and I think analgesics would be the best. If infection is there I request you to let that course as recommended by dentist to be completed. May be for five more days then you should operate that tooth. What I can do is change your analgesic and suggest some other analgesic. But for that you have to tell me are you having hypertension or any systemic disorder. If you can send me x-ray, I can suggest what procedure could be performed.

The Probable causes

Trauma.

Differential diagnosis

Traumatic injury or necrosed pulp.

Probable diagnosis

Irreversible pulpitis to be confirmed after history and picture.

Regarding follow up

If possible please share history and picture. May be change in medication could help you relieving your pain.

Patient's Query

Thank you doctor,

Is it not possible for the x-ray to pick up any crack in the tooth?

Answered by Dr. Bharat Joshi

Hello,

Welcome back to icliniq.com.

Are you asking x-ray is not possible?

Patient's Query

Thank you doctor,

I was asking whether it would have been possible or not for the x-ray to detect any crack in the tooth if it was too fine i.e. a hairline crack. I am asking this because yesterday the dentist had taken an x-ray of the tooth and it showed no crack. On the same note, would it have been possible for a thin crack to result in immediate infection of such pain and severity?

Answered by Dr. Bharat Joshi

Hello,

Welcome back to icliniq.com.

X-rays can detect minor changes even fractures also. So if the dentist had taken x-ray and there was no observation, then either the crack is not due to fracture or it is not so fine to be detected because radiographs need at least 400 um destruction of enamel. Second thing is yes trauma can cause irreversible pulpal damage or necrosis also but since x-ray is not possible so you do not consider this fine crack as causative agent. I request you to complete the course and whenever you are going for the treatment request that dentist to give you an x-ray or RVG (radiovisiography) picture so that I can definitely relate my assumptions with the radiograph.

The Probable causes

Trauma.

Investigations to be done

X-ray or RVG.

Differential diagnosis

Irreversible pulpitis but an x-ray is must.

Probable diagnosis

Necrosed pulp but an x-ray is must.

Treatment plan

Probably root canal or extraction.

Preventive measures

Avoid hard food eating and biting on involved tooth.

Regarding follow up

Whenever going for treatment you can send me the picture of an x-ray. In case you want to change the medicine you can reply me immediately.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Bharat Joshi
Dr. Bharat Joshi

Dentistry

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