TABLE 522 Findings in the Gums and Teeth

Phenytoin GumsBlunted Interdental Papillae

Marginal Gingivitis

Marginal gingivitis is common among teenagers and young adults. The gingival margins are reddened and swollen, and the interdental papillae are blunted, swollen, and red. Brushing the teeth often makes the gums bleed. Plaque—the soft white film of salivary salts, protein, and bacteria that covers the teeth and leads to gingivitis—is not readily visible.

Acute Necrotizing Ulcerative Gingivitis

This uncommon form of gingivitis occurs suddenly in adolescents and young adults and is accompanied by fever, malaise, and enlarged lymph nodes. Ulcers develop in the interdental papillae. Then the destructive (necrotizing) process spreads along the gum margins, where a grayish pseudomembrane develops. The red, painful gums bleed easily; the breath is foul.

Chronic Gingival Enlargement Images

Chronic Gingivitis and Periodontitis

Chronic, untreated gingivitis may progress to periodontitis—inflammation of the deeper tissues, that normally hold the teeth in place. Attachments between gums and teeth are gradually destroyed, the gum margins recede, and the teeth eventually loosen. Calculus (calcified plaque), seen here as hard, cream-colored deposits on the teeth, contributes to the inflammation.

Gingival Hyperplasia

Gums enlarged by hyperplasia are swollen into heaped-up masses that may even cover the teeth. The redness of inflammation may coexist, as in this example. Causes include Dilantin therapy (as in this case), puberty, pregnancy, and leukemia.

(Sources of photos: Marginal Gingivitis, Acute Necrotizing Ulcerative Gingivitis—Tyldesley WR: A Colour Atlas of Orofacial Diseases, 2nd ed. London, Wolfe Medical Publications, 1991; Chronic Gingivitis and Periodontitis (Courtesy of Dr. Tom McDavid), Gingival Hyperplasia (Courtesy of Dr. James Cottone)—From Langlais RP, Miller CS: Color Atlas of Common Oral Diseases. Philadelphia, Lea & Febiger, 1992. LJsed with permission.)

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