What are Aphthous
Ulcers?
Aphthous ulcers - commonly are also known as canker
sores - are small, painful sores that occur inside the
mucosa pink tissue that covers the inside of the mouth
of oral cavity. They are the most common ulcer that
affects the inside mouth, yet their reasons are unknown.
Many reasonns point to them as an allergic reaction
as a possible cause; toothpaste contents (specifically
sodium lauryl sulfate, or SLS), taste flavoring agents
in food, and mouthwashes have all been identified as
common reasons for allergic reaction. Some people also
experience severe episodes of aphthous ulcers during
stressful periods.
Typically, the mouth ulcers are small may be pin point
in size and are most common on the inside of the cheeks
or lips, the 'valley' between the lips and the gums,
and on the tongue. They can occur at any age, but are
most common in those between 20-40 years of age. They
also tend to be more common in females.
Aphthous ulcers often develop in a cyclic pattern, and heal without scarring within 10-14 days. Generally, they have to run their course, although there are a few products available that can temporarily relieve the discomfort produced by these mouth sores. You should avoid acidic foods and beverages, like orange juice and tomatoes, until the ulcers subside; it can be very painful when the ulcers come in contact with acidic substances.
Treatment Options
At this time, there is no cure for aphthous ulcers, unless
your condition is caused by an allergic reaction that
we are able to identify and remove. Prescription mouth
rinses that contain tetracycline (an antibiotic), Benadryl
(an antihistamine), and cortisone, either used individually
or in combination, have been beneficial for some people,
but their effectiveness is unpredictable and does not
last.
Supplemental vitamins and minerals, such as vitamin B12,
iron, and zinc, have been used with mixed results. Over-the-counter
treatments are available that can alleviate some of the
discomfort associated with aphthous ulcers. They either
numb the area, or place a protective film over it.
What is an Apical Periodontal Cyst?
An apical periodontal cyst, also called a radicular cyst,
is a mass of soft tissue that is characterized by having
a fluid-filled central cavity (called a lumen) that develops
around the lower 1/3 of a tooth root, either at the bottom
or along the side of the root. They often form as a result
of a dental granuloma, a proliferating mass of infected
tissue and bacteria that forms in response to dead tissue
within the pulp chamber of the tooth. The death of the pulp
may be due to extensive decay, deep restorations, or trauma
to the tooth.
Radicular cysts usually present no symptoms unless a secondary
infection develops. They range in size from two millimeters
to three centimeters, and may have either welldefined or
ill-defined borders. The larger lesions tend to be better
defined and may overlap the root tips of several teeth.
Radicular cysts of this type tend to be long-standing. Radicular
cysts usually enlarge slowly, and rarely displace teeth
or expand bone as they grow. They can occur at any age in
response to a non-vital (dead) tooth, but are most common
among those in their 30's and 40's.
What is a Biopsy?
If we cannot easily diagnose a growth or lesion by examining it visually, we will often recommend a biopsy. When we perform a biopsy, we surgically remove tissue - either a small, representativeportion, or the entire lesion - then send it to a laboratory for microscopic analysis. In many cases, the definite diagnosis cannot bemade without this microscopic examination. In some situations, we will perform the biopsy in our office, using the same local anesthetic that we use for routine dental procedures, like fillings. We may also refer you to a dental specialist to perform the biopsy procedure.Biopsies are typically painless and the lining of the tissues within your mouth (called the mucosa) normally heal very rapidly. Rinsing with warm salt water is often the only treatment that we recommend to minimize discomfort and prevent infection. Dissolve one teaspoon of salt in a cup of warm water, then gently swish and spit.
When We Will Recommend a Biopsy
. When careful examination, together with your medical
and dental history, fails to lead to a diagnosis.
. When careful examination, together with your medical
and dental history, fails to lead to a diagnosis.
. When we believe the lesion may be pre-cancerous (as
is often the case with white lesions such as leukoplakia,
hyperkeratosis, or epithelial hyperplasia).
. When lesions that we believe are non-cancerous do
not respond to treatment.
. When there is some factor in your health history or
lifestyle, such as the prolonged use of alcohol or tobacco,
which might predispose you to developing oral cancer.
. When the lesion shows visual signs of being cancerous;
it's longlasting or increases rapidly in size, for example,
or it ulcerates, extends beneath the surface, or adheres
to the adjacent tissues. We may decide to refer you
to an oral and maxillofacial surgeon for your biopsy.
If this is the case, it is crucial that you follow through
without delay.
. When we believe the lesion may be pre-cancerous (as
is often the case with white lesions such as leukoplakia,
hyperkeratosis, or
epithelial hyperplasia).
. When lesions that we believe are non-cancerous do
not respond to treatment.
. When there is some factor in your health history or
lifestyle, such as the prolonged use of alcohol or tobacco,
which might predispose
you to developing oral cancer.
. When the lesion shows visual signs of being cancerous;
it's longlasting or increases rapidly in size, for example,
or it ulcerates, extends beneath the surface, or adheres
to the adjacent tissues.
We may decide to refer you to an oral and maxillofacial
surgeon for your biopsy. If this is the case, it is crucial
that you follow through without delay.
What is Cellulitis?
Cellulitis is a severe, rapidly-spreading bacterial infection
that results from an uncontrolled infection in the gums,
tooth pulp or root end (apex). It normally starts close
to the source of the original infection, and quickly spreads
to involve large areas of the face and neck. It is characterized
by swelling, redness, heat and pain. Symptoms of cellulitis
include a painful, tender swelling that increases in size
as the infection spreads, and a stretched, shiny appearance
to the skin. Overall, you may have a fever, fatigue and
muscle aches, swollen lymph glands in the neck, nausea and
vomiting, joint stiffness, and hair loss at the affected
area.
Treatment Options
Cellulitis can be difficult to treat, and may require hospitalization. The focus of the treatment is to stop the infection's spread, establish drainage, and prevent the development of complications. It is important that we identify the type of bacteria causing the infection. After this has been done, we can usually cure cellulitis after 7-10 days of treatment, except in those with suppressed immune systems.
. We will prescribe antibiotics to control the infection;
intravenous antibiotics may be required if your infection
is severe.
. Pain medication may also be prescribed, if over-the-counter
pain medication does not offer adequate relief.
. To minimize the swelling associated with the infection,
elevate the affected area.
. Avoid strenuous activity; rest until symptoms subside.
If allowed to progress, cellulitis can be life-threatening.
Progression of the infection can result in death of the
tissues (gangrene), an infection throughout the body (sepsis),
inflammation of the lymph vessels (lymphangitis), or meningitis.
What is a Dental Fistula?
A dental fistula (also called a parulis or a gum boil) forms
in response to an infection at the base of the tooth's root
(called the apex). They can also form in reaction to an
abscess, cyst or other inflammation within the mouth. Fistulae
are essentially channels that form within the bone and/or
soft tissue to give infection an avenue for drainage. They
typically occur on the gums or the roof of the mouth, but
not necessarily near the source of the infection. Often,
fistul e take extremely indirect routes before they reach
the skin's surface to drain. The parulis is the term given
to the point at which the fistula reaches the suface, presenting
itself as a small pimple on the gum or palate (or, less
frequently, on the skin of the face or neck). The parulis
will usually rupture to form an opening. This small wound
may heal and recur from time to time. Fistulae can be difficult
to detect. They do not show up on an x-ray, and they do
not always reach the surface to drain through a parulis
or gum boil. Furthermore, they can be completely non-painful,
or they may cause slight pain just prior to drainage. This
can be a problem, because a persistent infection can occur
if fistulous tracts go undetected for long periods of time.
Treatment Options
We will treat the source of the infection by:
. Performing root canal therapy
. Draining the abscess
. Removing the cyst
. Treating the infection with antibiotics
. Treating long-standing fistulous tracts with surgery
or cauterization to resolve any infection at the parulis.
What is Denture Hyperplasia?
Denture hyperplasia is characterized by a smooth, tumor-like
mass that forms within the space between the cheek and the
gums (the vestibular sulcus) in response to chronic irritation
caused by the flange of a poorly-fitting denture. It also
occurs in the lower jaw between the inside surface of the
gums and the floor of the mouth. It is most common in those
with immediate dentures, or in those who have worn the same
denture (complete or partial) for many years. With time,
dentures become loose or ill-fitting due to bone loss and
shrinkage of the gums. This in turn causes the denture borders
to rub excessively into the vestibular sulcus or floor of
the mouth. This causes irritation and increased thickness
in these tissues, resulting in denture hyperplasia. Initially
the mass is soft and smooth, but becomes grooved, knob-like
and firm as it enlarges. The grooves on the mass can become
ulcerated and swollen, causing the mass to be quite painful.
A condition called papillary hyperplasia, another condition
that can affect long-term denture wearers and that is characterized
by multiple small, merging, pimple-like lesions on the soft
palate, can accompany denture hyperplasia. Denture hyperplasia
occurs most often in individuals of either sex who are over
40 years of age. Without treatment, the condition will persist
and will increase in size and degree of ulceration; this
lends itself to infection.
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