Dental Health: gingivitis, oral ulcers, bleeding gums

My daughter had a deep cleaning a couple months ago and she was diagnosed with gingivitis, with ulcers and bleeding. We are looking for supplemental treatments to mouthwash and teeth/gum brushing. My daughter is in a lot of pain and this is affecting her eating.

It is quite common for young adults with CdLS to express some form of periodontal disease, to one degree or another. Difficulty in maintaining good oral hygiene is a result of the limited oral opening, the defensive nature of the child when you are trying to brush and the poor oral swallowing mechanism that leaves food debris and plaque in the mouth. This build up of plaque, tartar and food debris can irritate the gingiva (gums) and cause swelling of the gums, which is gingivitis. Bleeding can follow as the severity of the gingival swelling and tissue breakdown progresses. The ulcerations are a possible sequellae, as the surface tissues further breakdown. Also, the ulcerations could be viral and express themselves as ulcers in an opportunistic environment of damaged gum tissues. The condition needs to be evaluated by a family dentist or even a periodontist (gum specialist). A professional cleaning and scaling should be done. This might have to take place while the patient is under sedation or general anesthesia for a safe and effective procedure. Once the teeth and gums have been cleaned properly, then home care techniques can be re-enforced and altered to improve the day to day brushing and oral care. There are various medications that can help start and maintain the healing process for good healthy gums:<: Peridex—chlorahexadine oral rinse—It is a prescription drug. It can be applied to the gums, after brushing, by using “toothette” sponges. We do not expect the patient to be able to swish and expectorate properly, so the sponges can be a good way of getting the medicine onto the tissues throughout the mouth. Peroxyl— a non-prescription medication that is a hydrogen peroxide based mouth rinse that will loosen up plaque and debris and help oxygenate the gums and heal them. It can be applied via the toothettes, prior to brushing. Orabase-B—over the counter–topical anesthetic gel—it will take away the pain. Use when necessary and especially before eating to make it more comfortable. If the ulcers are viral (herpetic gingivostomatitis), they will take two weeks to go away. The above medications will make things better. If a fever has been present, Motrin or Tylenol can be used. Dehydration is the major problem we worry about, and we recommend forcing liquids, Popsicles, ice cream, smoothies, etc. Use bland pureed foods until a normal diet is tolerated. Consult with your physician if you feel she is losing weight or getting dehydrated.

RM – TK 3/25/11