This document discusses various abnormalities and diseases of the gums. It begins by describing gingivitis, the signs and symptoms which include painful, inflamed, and swollen gums that bleed easily. Gingivitis is a reversible form of gum inflammation caused by poor oral hygiene. The document then discusses necrotizing gingivitis, herpetic gingivostomatitis, and periodontitis - all diseases affecting the gums. It provides the signs, symptoms, causes, and nursing considerations for each. The document concludes by covering topics like dental decay, prevention methods, mouth care, diet, fluoridation, and pit and fissure sealants.

1. ABNORMALITIES OF THE
GUMS
PRESENTED BY:
V.RAMYA,
TUTOR,
SRMTCON.

2. GINGIVITIS

3. SIGNS AND SYMPTOMS
• Painful,
• inflamed,
• swollen gums;
• Usually the gums bleed in response to light
contact

4. POSSIBLE CAUSES AND SEQUELAE
• Reversible form of inflammation of the gingiva
• (I,e.,mild form of periodontal disease)
• Associated with poor oral hygiene:
• Food debris ,bacterial plaque,and calculus (tartar)accumulate.
• Gums may also swell in response to normal processes such as puberty and
pregnancy ,
• with certain medications (phenytoin,dilantin) ,

5. POSSIBLE CAUSES AND SEQUELAE
• Calcium channel blockers
• Cyclosporine
• Or with deficiency in the immune system
(i.e.,AIDS )
• Or nutritional status.

6. NURSING CONSIDERATIONS
• Educate patient about proper oral hygiene
• Tooth – brushing , flossing, rinsing (i.e., chlorhexidine)
• Dental appointments every 3 -6 months
• Remove casual agents as appropriate – medications
,smoking ,dental appliances.

7. NECROTIZING GINGIVITIS
•Trench mouth

8. SIGNS AND SYMPTOMS
• Gray – white pseudomembrane ulceration affecting the
edges of the gums ,
• mucosa of the mouth ,
• tonsils and pharynx
• halitosis ;
• painful

9. SIGNS AND SYMPTOMS
•Bleeding gums
•Swallowing and talking are painful

10. POSSIBLE CAUSES AND SEQUELAE
• Progressive ,
• painful bacterial infection
• Related to poor oral hygiene ,
• lack of access to dental care,
• inadequate rest,

11. POSSIBLE CAUSES AND SEQUELAE
•Emotional stress ,
•Smoking
•Poor nutrition
•Over work

12. NURSING CONSIDERATIONS
• Educate patient about oral hygiene
• Irrigate with 2- 3% hydrogen peroxide or normal
saline solution.
• Avoid irritants such as smoking and spicy foods.

13. Herpetic gingivostomatitis

14. SIGNS AND SYMPTOMS
• Burning sensation with the appearance of small vesicles
24- 48 hours later
• Vesicles may rupture
• Forming sore
• Shallow ulcers covered with a gray membrane .

15. POSSIBLE CAUSES AND SEQUELAE
• Herpes simplex viral infection
• Occurs most frequently in people who are immune suppressed ;
• May occur in other infectious processes such as streptococcal
pneumonia;
• meningococcal meningitis and
• Malaria.

16. NURSING CONSIDERATIONS
• Apply topical anesthetics as prescribed;
• May need opioids if pain is severe.
• Saline or 2-3% hydrogen peroxide irrigations
• Antiviral agents such as acyclovir may be
prescribed.

17. PERIDONTITIS

18. SIGNS AND SYMPTOMS
• Little discomfort at onset ;
• May have bleeding
• Infection
• Gum recession
• And loosening of teeth;

19. SIGNS AND SYMPTOMS
•Later in the disease
•Tooth loss may occur .

20. POSSIBLE CAUSES AND SEQUELAE
• Deep ,
• Chronic inflammation of the gingiva
• May result from untreated gingivitis
• Poor or inadequate dental hygiene and inadequate
diet contribute to development.

21. NURSING CONSIDERATIONS
• Instruct patient in proper oral hygiene ,
• Chlorhexidine rinses.
• Instruct patient to consult a dentist or periodonist for
antibiotic prescription,
• Deep root scaling.

22. DENTAL DECAY

23. DENTAL DECAY
• Dental decay begins with a small hole ,usually in a fissure ( a break in the
tooth enamel)
• Or in an area that is hard to clean .
• Left unchecked ,the decay extends to the dentin.
• Because dentin is not as hard as enamel, decay progresses more rapidly and
in time reaches the pulb of the tooth

24. DIAGNOSIS
• Gum Examination

25. HOW ITS DONE
•The dentist will examine your gums for
signs of inflammation and use a tiny ruler
called a “probe” to measure pockets
around the teeth.

26. Why it’s done
•In a healthy mouth, the pockets around the
teeth are usually between 1 and 3 millimeters.
•Deeper pockets can be a sign of periodontal
disease.

27. Medical History Survey

28. HOW ITS DONE
•The dentist will ask questions about
your medical history.

29. Why it’s done
•Certain conditions or risk factors,
like smoking or diabetes, can
contribute to gum disease.

30. X-Ray

31. HOW ITS DONE
•X-ray images of the teeth and
mouth are taken.

32. Why it’s done
•An x-ray can show if there is any
bone loss as a result of gum
disease.

33. PREVENTION
• Measures used to prevent and control primary dental caries include applying
fluoride varnish/ gel
• Using fluoride tooth paste
• Applying dental sealants and
• Ensuring community water fluoridation
• Other recommendations include implementing daily oral hygiene practices

34. PREVENTION
• Seeking routine professional treatment
• Refraining from smoking and excessive alcohol use
• Making good dietary choices
• And managing related systemic diseases.

35. MOUTH CARE
• Healthy teeth must be cleaned on daily basis .
• Brushing and flossing are particularly effective in mechanically breaking up
the bacterial plaque that collects around teeth.
• Mastication (chewing) and the normal flow of saliva also aid greatly in
keeping the tooth clean.
• Because many ill patients do not consume adequate nutrients ,they produces
less saliva ,which in turn reduces this natural tooth – cleaning process.

36. MOUTH CARE
• The nurse may need to assume the responsibility for brushing the patients
teeth.
• Merely wiping the patients mouth and teeth with a swab is ineffective.
• The most effective method is mechanical cleansing (brushing)
• If brushing is not possible ,it is better to wipe the teeth with a gauze pad and
then have the patient swish an antiseptic mouthwash several times before
expectorating into an emesis basin.

37. MOUTH CARE
• A soft – bristled toothbrush is more effective than
a sponge or foam stick.
• Flossing should be performed daily.
• To prevent drying,the lips may be coated with a
water -soluble gel.

38. DIET
• Dental caries may be prevented by decreasing the amount of
sugar and starch in the diet.
• Patients who snack be encouraged to choose less caloric
alternatives
• Such as fruits ,vegetables ,nuts, cheeses, or plain yogurt.
• Brushing after meals is recommended.

39. FLUORIDATION
• Fluoridation of public water supplies has been found to decrease dental
caries.
• Studies suggest that by instituting a community water fluoridation program,
tooth decay is reduced by 25% in both children and adults.
• Consuming drinking water which has higher levels of fluoride greater than
the recommended 1 mg/L.
• Tamilnadu, west Bengal, Uttar Pradesh ,Assam ,and Bihar suffer mildly with
fluorosis.

40. PIT AND FISSURE SEALANTS
• The occlusal surfaces of the teeth have pits and fissures- that are
prone to caries.
• Some dentists apply a coating to fill and seal these areas on the
primary and permanent molars to protect them from potential
exposure to cariogenic processes.
• These sealants can last at least 48 months and significantly prevent
tooth decay.

41. periapical abscess

42. INTRODUCTION
•A periapical abscess ,more commonly
referred to as an abscessed
tooth,involves a collection of pus in
the apical dental periosteum

43. TYPES
•An acute periapical abscess
•An chronic periapical abscess

44. An acute periapical abscess
• An acute periapical abscess arises from an infection,
• Usually secondary to dental caries.
• The infection of the dental pulb extends through the
apical foramen of the tooth to form an abscess around
the apex.

45. An chronic periapical abscess
• A chronic periodontal abscess occurs from a slowly progressive infectious
process.
• The infection eventually leads to a ‘’BLIND DENTAL ABSCESS” which is
actually a periapical granuloma.
• It may enlarged to as much as 1 cm in diameter.
• It is often discovered on x-ray images and is treated by extraction or root
canal therapy ,often with apicoectomy ( excision of the apex of the tooth
route).

46. CLINICAL MANIFESTATIONS
• The abscess produces a dull,
• gnawing ,
• continuous pain,
• often with a surrounding cellulitis and
• Edema of the adjacent facial structures and
• Mobility of the involved tooth.

47. CLINICAL MANIFESTATIONS
• The gum opposite the apex of the tooth is usually
swollen on the cheek side.
• Swelling and cellulitis of the facial structures may make it
difficult for the patient to open the mouth.
• There may also be a systemic reaction,fever and malaise.

48. MEDICAL MANAGEMENT
• In the early stages of an infection, a dentist or oral surgeon may
perform a needle aspiration or drill an opening in to the pulb
chamber to relieve pressure and pain and to provide drainage.
• Drainage is provided by an incision through the gingiva down to
the jaw bone.
• Purulent materials escapes under pressure.

49. SURGICAL MANAGEMENT
• After the inflammatory reaction has subsided ,the
tooth may be extracted or root canal therapy
performed.
• Antibiotics ,in the presence of over spreading
infection,and analgesics may be prescribed.

50. NURSING MANAGEMENT
• The patient is assessed for bleeding after treatment and is instructed to use a
warm saline or warm water mouth rinses to keep the area clean.
• The patient is also instructed to take antibiotic and analgesic agents as
prescribed.
• To advance from a liquid diet to a soft diet as tolerated, and
• To keep follow - up appointments.

51. BIBLIOGRAPHY
• Brunner and Suddarth’s Text book of Medical – Surgical Nursing South Asian
edition volume I ,Page referred 842 -845
• Ansari and kaur ,Medical – Surgical Nursing ,Published by Pee vee, 2011 edition,
page referred 446-460.
• https://www.slideshare.net/USDentalCenter/gums-disease
• https://www.slideshare.net/SherifTehemar/gum-diseases
• https://www.slideshare.net/KyleLarson8/gum-disease-an-overview-102337156

52. THANK YOU