Oral and dental conditions

Long-term denture wear can cause epulis fissuratum (folds of tissue from an ill-fitting denture), a flabby mobile ridge, or combination syndrome (anterior maxillary resorption against natural lower teeth). Manage with denture adjustment or new dentures, antiseptic rinses and oral gel, and surgical excision of persistent lesions.

Gingival hyperplasia is overgrowth of the gums from medicines (anticonvulsants, immunosuppressants, calcium channel blockers), hormones or heredity; desquamative gingivitis is red, glazed, peeling gingiva often from lichen planus. Treat the cause, give oral hygiene care, antiseptic mouthwash and gel, gingivectomy for hyperplasia and topical triamcinolone for desquamative gingivitis.

Peri-implantitis is inflammation with bone loss around a dental implant; a periodontal abscess is acute infection in a periodontal pocket; and systemic diseases such as diabetes and HIV cause periodontitis out of proportion to local factors. Treat with drainage or debridement and scaling, analgesics, antiseptic mouthwash and gel, and amoxicillin, erythromycin or doxycycline with metronidazole, while managing the systemic disease.

Cervicofacial necrotizing fasciitis is a life-threatening polymicrobial infection, usually after a dental infection or extraction, with pain out of proportion, spreading swelling, crepitus, dusky skin and rapid necrosis. Admit, debride surgically with daily dressings, and give IV ceftriaxone with metronidazole (and gentamicin), investigating as for Ludwig's angina.

Angular cheilitis is soreness, redness and fissuring at the corners of the mouth from reduced facial height, lip licking, poor-fitting appliances, nutritional deficiency or infection (fungal or bacterial). Correct the cause and use nystatin or miconazole for fungal and an antiseptic gel for bacterial infection, with fluconazole or itraconazole for severe cases.