What is Lateral Periodontal
Abscess?
A lateral periodontal abscess is a result of rapidly-growing
bacteria within a periodontal pocket. A periodontal pocket
forms in the
presence of periodontal disease, as the gums become infected
and pull away from the surface of the teeth. This deepens
the sulcus - the space between the teeth and gums - to
a space greater than three millimeters. The deepened sulcus
is called a pocket.
An abscess forms when the pocket deepens
to the point that plaque bacteria, tartar and/or food
become trapped within it, and the body's immune system
cannot adequately combat the infection. A large swelling
develops on the gums as a result of this uncontrolled,
rapid growth of bacteria, bacterial products and infected
gum tissue. As a result, what occurs is a fast, painful
destruction of the supporting connective tissue and bone
that surround the tooth.
Lateral periodontal abscesses form anywhere
along the side of the gums where the periodontal sulcus
has deepened to become a pocket. They are common in cases
of advanced periodontal disease, when bone loss has occurred
as a result of the infection, because the pocket depth
of five millimeters or more creates an ideal environment
for abscess formation.
Abscesses can be very painful, tender lesions
that often appear suddenly. Even small abscesses can produce
a great deal of pain. Abscesses are most common in those
40 years old and above, but occasionally occur in children.
Lateral periodontal abscesses are smooth
to the touch and range in diameter from two to ten centimeters.
In some cases, they form as a result of an immune system
disorder or deficiency, or uncontrolled diabetes.
What is Leukoedema?
Leukoedema is characterized by a widespread whitening
of the inner lining of the cheek or other mouth tissues,
due to an increase in the amount of fluid being retained
by the skin's cells. Leukoedema is persistent, and is
most common in individuals with dark skin. The cause of
this condition is unknown. Leukoedema is much like another
abnormal condition, leukoplakia, in that both give the
inner mouth tissues a white appearance. A simple test
to verify the condition is to stretch the skin over the
fingers; if the normal pink color returns, it is leukoedema.
It is important that we distinguish leukoedema from leukoplakia,
as leukoplakia can be a pre-cancerous condition and should
be biopsied for an accurate diagnosis.
Treatment Options
Leukoedema is really a variation of normal and no treatment
is necessary. If there is also leukoplakia present, which
is not uncommon, then a biopsy (the microscopic examination
of a tissue sample) is in order to ensure that there have
been no significant changes in the tissue or the cells.
What is Leukoplakia?
Leukoplakia is a white patch-like lesion that develops on
the mucous membranes within the mouth in response to chronic
irritation. The lesions occur primarily on the tongue and
the inside of the cheek, but also occur frequently on the
inner or outer surface of the lips and the floor of the
mouth. However, any oral site may be affected. The lesions
associated with leukoplakia are white or gray, slightly
raised, and can be either rough or smooth. They often have
a corrugated or fissured appearance, caused by abnormal
thickening of the outer layer of the mouth's lining (the
epithelium). These lesions are painless, yet are pre-cancerous
in approximately 15 percent of the cases, and for this reason
should never be ignored. Use of tobacco (especially pipe
and smokeless tobacco) and alcohol, chronic lip or cheek
biting, ill-fitting dentures, and poor oral hygiene are
primary irritants that can cause leukoplakia. However, local
infections such as herpes, systemic disease, environmental
toxins and malnutrition have also been shown to be factors
that contribute to the incidence of leukoplakia. Occasionally,
there is no obvious cause. Leukoplakia occurs most frequently
in men over 40. However, with the increased use of smokeless
tobacco (snuff) among teenagers and young adults, the incidence
of leukoplakia is increasing among this group as well. The
affects that the irritants have on the lining of the mouth
can vary significantly between individuals; some can endure
a great deal of irritation with minimal change in the tissues,
while others experience significant tissue change with only
moderate irritation.
Treatment Options
Our goal in treating your leukoplakia is to eliminate
the lesion. This can usually be accomplished by removing
the irritant. However, most leukoplakias that have been
present for very long periods (weeks to months) will have
to be removed surgically. Biopsy (microscopic examination
of a tissue sample) is a must for all leukoplakias in
order to make an accurate diagnosis. The microscopic changes
can range from no dysplasia (abnormal tissue growth) to
mild, moderate, or severe dysplasia. Occasionally, there
may be
cancerous changes present in the tissues; only microscopic
examination via a biopsy can distinguish these changes.
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What is Lichen Planus?
Lichen planus is a disease that occurs within the mouth
or on the skin, or may involve both sites. There are three
types of lichen planus. The most common type is reticular
lichen planus, discussed below. The second type is erosive
lichen planus, a long-term and
often very painful condition. These two types can often
occur simultaneously within your mouth. The third type
is hypertrophic lichen planus, which is less common and
is characterized by thick, white, plaque-like areas within
the mouth.
The oral lesions of reticular lichen planus are characterized
by multiple white, pimple-like sores that multiply rapidly,
then merge to form a linear, circular, or mesh-like pattern;
a lacey-appearing network of lesions is common. Lichen
planus lesions on the skin are purple,
polygon-shaped, and itchy. This condition can be difficult
for us to identify because of the many variations possible
in the appearance of the lesions.
The oral lesions may appear at any site within the mouth,
but are most common on the tissue lining the inside of
the cheeks (called the
mucosa), the sides of the tongue, and the space between
the lips and the cheeks (called the vestibule or sulcus).
They occur most in those at or over middle age, and are
very rare in children. The lesions, which don't present
any symptoms other than tenderness, come and go at unpredictable
intervals lasting for weeks or even months at a time.
Lichen planus lesions tend to flare up during stressful
conditions. The precise cause is unknown, but it is believed
that the condition occurs with higher incidence in those
with diabetes, immune system deficiencies, or high blood
pressure. It also has been shown to be more common in
females.
What is Lymphoid Hyperplasia?
Lymphoid hyperplasia is not a disease or a tumor, but
simply a term we use to represent enlarged tissue masses.
Normal lymphoid tissue is found in your lymph nodes and
tonsils. These tissues act as your body's first line of
defense against infections. Lymphoid hyperplasia exists
when these masses suddenly form and enlarge in locations
not typical for lymphoid tissue, such as on the rear top
surface of the mouth or along the sides of the tongue.
They can also form on the gums, the floor of the mouth,
at the back of the throat or the inside of the cheeks.
The enlarged masses usually form in response to some
form of irritation, such as an infection in the immediate
area or a generalized upper respiratory infection. Tissue
masses associated with lymphoid hyperplasia may be tender
and reddened, and range in size from small growths of
2 to 5 centimeters (called tissue tags) to nodules up
to a centimeter or more in diameter.
Treatment Options
• Treating the infection will typically cause the
tissue to return to normal size.
• If the tissue does not regress to normal size after
the infection subsides, we will need to take a tissue
sample and examine it with a
microscope to be sure it is not cancerous. This is called
a biopsy.
• To avoid continued irritation, we may surgically
remove the masses that do not regress on their own.
