Mouth conditions, bleeding and painful gum

Question 1

Probability diagnosis

Answer 1

Factitious: excessive brushing

Gingivitis/periodontal (gum) disease

Trauma: poor-fitting or partial dentures

Drugs: warfarin overdose, phenytoin

Question 2

Serious disorders not to be missed

Answer 2

Oral cancer/benign neoplasms (e.g. epulis, SCC)

Blood dyscrasias (e.g. AML)

General coagulation defects

HIV/AIDS

Acute herpetic gingivostomatitis

Question 3

Pitfalls (often missed) but uncommon

Answer 3

Acute necrotising ulcerative gingivitis (Vincent infection)

Autoimmune disease (e.g. lichen planus, SLE)

Hereditary haemorrhagic telangiectasia

Malabsorption

Nutritional deficiency (e.g. scurvy)

Hormonal (e.g. pregnancy)

Question 4

Key clinical features

Answer 4

Erythematous bleeding gums are a common worldwide problem, which is almost always a localised inflammation associated with poor dental hygiene.

Consider systemic problems usually as part of a bleeding diathesis

Excluded haematological disorders such as;

• coagulation defects
• acute leukaemia
• agranulocytosis

Question 5

Acute necrotising ulcerative gingivitis

Answer 5

Also, known as Vincent infection or trench mouth

caused by anaerobic organisms

rarely seen but is more common in undernourished or ill young adults under stress.

Question 6

vestigation

Answer 6

may not be necessary

• FBE
• ESR
• wound swab
• autoimmune screen
• INR.

Consider dental referral.