Photo Quiz: A Bump on the Gum

• Published in: American family physician Vol. 99; no. 11; p. 713
• Main Authors: Lam, Nguyet-Cam, Te, Tue T
• Format: Journal Article
• Language: English
• Published: Leawood American Academy of Family Physicians 01-06-2019
• Subjects: Abscesses; Airway management; Granulomas; Infections; Pain; Teeth; Ulcers
• ISSN: 0002-838X

Computed tomography is particularly sensitive for osseous structures and is the modality of choice for most odontogenic infections.2 Fluid collection and tissue biopsies should be examined for evidence of acute or chronic inflammation and infection. A spreading infection is more serious than localized swelling of gingival tissue, because the infection could spread outward from the root of the tooth throughout the bone and periosteum.3 Failure to recognize a systemic infection can lead to chronic infections or life-threatening complications, such as airway obstruction, mediastinitis, necrotizing fasciitis, cavernous sinus thrombosis, cerebral abscess, orbital abscess, and sepsis.4 Severe complications require intravenous antibiotics, incision and drainage, and probable removal of the source of infection.3 A localized infection is usually not urgent and can be managed in the outpatient setting. Pyogenic granulomas are erythematous, nonpainful, and smooth, and bleed easily when touched.8 SUMMARY TABLE Condition Characteristics Dental abscess Moderate to severe pain, swelling, sensitivity to hot and cold; may have history of a recent dental procedure Langerhans cell histiocytosis Bone and skin are most commonly affected; oral involvement is possible, most often manifesting as an intraoral mass, gingivitis, mucosal ulcers, and loose teeth; most common in children one to three years of age Mucocele Multiple episodes of swelling with periodic rupture, nontender, often appears inside the lower lip, most common in young children Pyogenic granuloma Rapidly growing, erythematous, nonpainful, smooth lesions that bleed easily Address correspondence to Nguyet-Cam Lam, MD, FAAFP, at [e-mail].