patients 50 yr old came to my office today complaining swellen gums since 5 days with higher grad tooth mability and bleeding gums..need doc all ur suggestions.. DX n treatment??



First of all ... Advice opg... It is the case of drug induced gingival enlargement which has been complicated due to presence of local factors. Extraction of hopeless 3 mobility Do complete oral prophylaxis which will help in reducing inflammation and swelling of gums and reduction in bleeding.. Pt is on hypertensive drug...Consult the physician for substitution of drug. Advice metrogyl 400 mg thrice a day for 5 days CHX mouthwash And warm saline rinses If you can post opg then it will be easy to plan the treatment of individual teeth.

Advice blood investigations also...

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Using any epileptic drugs ?. Any history of hematalogical abnormalities ? * Due to heavy crowding of teeth there is heavy calculus and gingival hypertrophy we can see . * cherry red swelling of gum tissue and profuse bleeding from gums may be due to poor oral hygiene , food impaction heavy calculus deposits will enhance the Infection of gingival tissue and profuse bleeding and severe halitosis from the mouth *

No sir there is no any drug history n systemic history..

Severe gingival infection due to poor oral hygiene , heavy calculus deposits , purulent exudation from the gum tissue . * halitosis may be the major complaint due to spreading and excuding from the gum tissue on to tooth surface . * due to heavy irritation with concrete like calculus results redness like cherry fruit and gingival hypertrophy and and swelling Looks like ripen cherry fruit . * bleeding from the swollen gums may be primary complaint . * first inflammation and pain swelling ,bleeding gums should control * for foul smell and purulent exudation from gingiva will be controlled by metrogyl 400mg 3 times in a day and b complex for multivitam In supplementation. * chlorhexidine r Listerine mouth wash for keeping the oral cavity clean fresh and healthy. * for minimising gingival infection patient has to take lot of citrus fruits and fresh seasonal fruits. * some times fresh fruit juices also very helpful for keeping the oral cavity healthy and fresh. * vitamin c chewable tab not recommended because at this stage if customer chew the tablet the pus infection blood and food debris will go along with tablet . So there may be peptic and other gastric problems may arise. * the loose tooth has to be removed first because sometimes the more loose tooth without gum support can escape in to tracheal r broncus and may cause sudden obstruction to respiratory excursions . * now a days in every tooth paste they r adding salt one of the ingredient to kill the harmful bacteria from the tooth surface . * keep r hold highly saturated warm salt water for a period of 10 minutes and see the progress after one week both the oral , throat , pharyngeal infections will go off . * due to mal acclusion , crowding of teeth in multi rows results food impaction and results garbage in the oral cavity . * any impacted , sticked, good in and around the teeth and in cavities will ferment and become acidic nature and it will aggravate tissue damage and tissue becomes more necrotic condition . * food high protein food egg , milk , mushroom. s and fish and green leafy vegetables and fresh vegetables for more antioxidants. * any haematological abnormalities cbp can rule out * any autoimmune diseases ?. * any drugs using for epilepsy ?.

It's drug induced gingival enlargement...due to amlodipine... -OPG is required (as it also looks associated with periodontitis...which has caused bone loss...n teeth r mobile ). - complete blood investigation.. - referral to his physician ..for d change of drug...along with physicians note if pt is on ecospirin.. - thorough scaling n root planning.. - antibiotic coverage ...both amox n metronidazole.. - mouthwash.. - gingival massage with local gum paint ( like dantox). - every appt recheck his bp. - after a week ..go for extraction of mobile teeth.. - in opg ...if there is no bone loss...then only gingivectomy is d treatment of choice... if bone loss is present...then gingivectomy is done along with flap surgery...

Clear case of DIGO (drug induced gingival overgrowth) complicated by local factors. You can refer case to periodontist, drug substitution and treatment based on individual and overall prognosis of teeth.

It's an acute case.. So doctor do a blood test.. To rule out AML.(acute myeloid leukemia) the if positive then refer to a hematologist ..

Looks drug induced,any history??,oral prophylaxis is must,though there will b a considerable amount of bleeding.. ask for an Opg to plan out xn or mesioden present(hidden)

Sir there is no any systemic history or any drug induced patient is hypertensive so he has only taking amlodipine drug since 4-5 yr

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Poor oral hygiene.. Chronic generalised periodontitis,. With scaling and root planning go for oral prophylaxis under the cover of antibiotics to reduce inflammatory component and go for periodontal flap surgery using modified widman flap for inflammatory as well as fibrotic(hyperplastic) component

Amlodipine is CCB which may cause gingival hypertrophy and in 1.7% cases.. local factors have exaggerated the enlargement.. first u do meticulous SRP.. prescribe vit c tab, ultigel for loc application, hexidine mouthwash and antioxidants..then consult phy and substitute the opg ang blood investigation too.. when inflammation subsides then do extraction of hopeless teeth ang gingivectomy..


Epileptic drugs use ... hematological disorders . Chronic agressive periodontitis???? Cherry red swollen gum ... drug side effect

Patients is taking only amlodipine since 4-5 yr as such no drug history or any systemic history

Ask history....i agree with @Dr. Chinmaya Ranjan Joshi sir could be aml......get a CBC and ESR done as well .....

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