What causes gum swelling in an area with a missing tooth?
Patient's Query
Hello doctor,
My gums adjacent to the front tooth are swollen because that part of it has no tooth, and hard foods have been creating pressure against it. Currently, I am taking the tablet Augmentin. Should I visit a dentist? I do not think it is a tooth issue. What could it be? Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
First of all, thank you very much for sharing the picture (attachment removed to protect the patient's identity). You are right. This area is swollen because there is no adjacent tooth. Secondly, you are taking a course of Augmentin (Amoxicillin and Clavulanic acid). I recommend that you first complete the course and then, probably, find the time (not an emergency) to visit the dentist so that this area can be replaced with a tooth. Till then, you need not worry.
I suggest you take an IOPA (intra-oral periapical radiograph) and RVG (Radio Visio Graphy).
The differential diagnosis could be epulis fissuratum. The probable cause could be a lost tooth. The probable diagnosis is gingival enlargement due to a missing tooth.
The treatment plan would involve completing the antibiotic course, followed by probably an FPD (fixed partial denture) prosthesis or implants. Good oral hygiene maintenance is important. After completion of the antibiotic course, if swelling increases or if more symptoms occur, kindly follow up after seven days.
I wish you good health.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
Yesterday, I went to see the dentist, and he took an X-ray, which indeed showed an infection in that tooth. The dentist cleaned my gums and teeth and put some solution into my gums.
However, I think I may have cracked that tooth on the same day because I remembered biting on something while eating that caused a ticking sound, which resulted in severe pain in that tooth that led me to see the doctor. Before that, there was no pain.
Nevertheless, the X-ray did not show any crack, so I was puzzled. So, I followed the dentist's prescription of 250 mg Moxilen and a painkiller. I suspect that the antibiotics may not be strong enough. Today, the pain in my tooth has become more severe, and I cannot bite on my food, as this gives me intense pain. The dentist also told me that the infected tooth was root canal-treated, though I cannot recall.
What is your suggestion now? Should I endure a few more days to see whether my condition will improve, and then return to see the dentist?
Kindly suggest.
Thank you.
Hi,
Welcome back to icliniq.com.
You are already taking antibiotics, and I think analgesics would be the best. If the infection is there, I request you to follow that course as recommended by the dentist to be completed. You can wait for five more days, following which you should operate on that tooth.
What I can do is change your analgesic and suggest another analgesic. But for that, you have to tell me whether you have hypertension or any systemic disorder. If you can send me the X-ray image, I can suggest what procedure could be performed.
The differential diagnosis could be a traumatic injury or necrosed pulp. The probable diagnosis is irreversible pulpitis, which needs to be confirmed after taking the history and reviewing the picture. If possible, please share your previous history and picture. Maybe a change in medication could help relieve your pain.
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
Can an X-ray not pick up any cracks in the tooth? Kindly suggest.
Thank you.
Hello,
Welcome back to icliniq.com.
Are you asking whether an X-ray of a cracked tooth is not possible?
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
I asked whether it was possible or not for an 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 took 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? Kindly advise.
Thank you.
Hi,
Welcome back to icliniq.com.
X-rays can detect minor changes, such as even fractures. So, if the dentist had taken an X-ray and if 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 μm (micrometer) destruction of enamel.
The second thing is yes, trauma can cause irreversible pulpal damage or necrosis, but since the crack was not visible on the X-ray, you do not consider this fine crack as a causative agent. I request you to complete the course of antibiotics, and whenever you are going for treatment, request the dentist to give you a picture of the X-ray or RVG (radiovisiography) so that I can definitely relate my assumptions to the radiograph.
I suggest you take an X-ray or RVG. The differential diagnosis could be irreversible pulpitis, but it can be confirmed only after taking an X-ray. The probable diagnosis could be a necrosed pulp, but it can be confirmed only after taking an X-ray.
The treatment plan probably involves a root canal treatment or an extraction. Whenever you go for the treatment, you can send me a picture of the X-ray. In case you want to change the medicine, you can reply to me immediately. Avoid eating hard foods and biting on the involved tooth.
I hope this helps.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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