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Abstract: 56-year-old Master Wu visited the Department of Stomatology with red, swollen, painful and abscessed gums, and requested tooth extraction because the toothache was affecting normal eating. After detailed oral examination, combined with surface tomography, periodontal abscess was diagnosed. After patient communication with the patient, the patient was informed that this disease did not require tooth extraction for the time being, and periodontal irrigation, abscess drainage, anti-inflammatory and periodontal basic treatment were recommended. After treatment, the symptoms of gum swelling, pain and pus overflow subsided, and eating returned to normal.
Basic information】Male, 56 years old
Disease Type】Periodontal abscess
Hospital】Nei Mongol Autonomous Region Women and Children’s Health Hospital
Date of consultation】December 2020
Treatment plan] Periodontal irrigation, abscess drainage, anti-inflammatory treatment (cefixime capsule and ornidazole capsule) + basic periodontal treatment (supragingival scaling and subgingival scraping)
[Treatment Period] 3 weeks of outpatient treatment, review after 1 month
Treatment effect】The symptoms of swollen and painful gums gradually subsided, the gums no longer overflowed with pus, and eating returned to normal.
I. Initial consultation
Mr. Wu, 56 years old, visited the stomatology department because of red, swollen, painful and pus-flowing gums with a painful expression, and asked for tooth extraction because the toothache affected normal eating. The patient was asked about his smoking history, disease history, 15-20 cigarettes per day, diabetes mellitus for 5 years, and regular medication for 4 years. After detailed oral examination, the patient was found to have bilateral lower posterior gingival redness and swelling, easy bleeding and pus overflow from the gingiva on probing, loose teeth, and curved tomography films were taken, and the preliminary diagnosis was periodontal abscess. After patient communication with the patient, the patient was informed that this disease did not require tooth extraction for the time being, and it was recommended to carry out periodontal basic treatment for the whole mouth.
II. Treatment history
The patient was advised to undergo periodontal irrigation, abscess drainage, and systemic anti-inflammatory symptomatic treatment, including regular oral cefixime capsules and ornidazole capsules, and mouth rinsing with compound chlorhexidine rinse after brushing in the morning and evening, and the periodontal abscess subsided after 3 days of treatment. Subsequently, the whole mouth periodontal basic treatment can be carried out, i.e. supragingival scaling and subgingival scraping. After the periodontal basic treatment, peroxide and saline can be used for rinsing and disinfection, and minocycline hydrochloride ointment can be used for intraperiodontal pocket administration, which can play a better anti-inflammatory and antibacterial role.
III. Treatment effect
The patient was treated in the outpatient clinic for a total of about 3 weeks, and the symptoms of swollen and painful gums gradually subsided, and the gums no longer overflowed with pus, and eating gradually returned to normal with good appetite. The patient initially thought her teeth could not be retained and needed to be extracted, but after the treatment she successfully retained her teeth. The patient followed the doctor’s advice and actively controlled her blood sugar. At the follow-up of 1 month, the patient had no obvious tendency to relapse and her periodontium basically remained in a healthy state.
IV. Notes
We are glad that the patient’s tooth pain, gum redness and swelling, and pus flow were controlled. However, for periodontal disease, the most important thing is daily care, usually brushing teeth in the morning and evening, rinsing mouth after meals, and using dental floss or flosser appropriately. Patients should also control the amount of smoking and try to quit smoking. For diabetes, it is important to follow up regularly with the endocrinology department to control blood sugar, control diet and strengthen physical exercise. Regarding oral medications, patients should not take them at their own discretion, but should use them under the guidance of a doctor.
V. Personal insight
Many patients want to extract teeth as soon as they come to the dentistry department feeling toothache, but some teeth do not need to be extracted and can be retained after treatment. Periodontal abscess can occur at all ages, especially in patients who smoke and those with diabetes. The disease often presents with swollen and painful gums, bleeding and overflowing pus, and the teeth may also shift, with large amounts of soft food and calculus adhering to the tooth surface. Doctors should provide psychological guidance to patients, let them understand their condition as much as possible, make regular return visits and urge them to follow up regularly. Good or bad blood sugar control and the amount of smoking will directly affect the treatment effect of periodontal abscess, so patients should be urged to reduce the amount of smoking and visit the endocrinology department regularly for follow-up. Doing periodontal basic treatment with discomfort will make patients resist periodontal treatment, but not doing treatment will aggravate periodontitis, doctors still need to communicate with patients patiently about their condition and help patients suggest confidence in treating the disease.