Introduction

Teeth and gum symptoms or complaints can be indicative of various dental and oral health conditions. These symptoms can range from mild discomfort to severe pain and can be caused by a variety of factors^[1]. This guide aims to provide a comprehensive overview of the symptoms, causes, diagnostic steps, possible interventions, and patient education related to teeth and gum symptoms/complaints.

Codes

• ICPC-2 Code: D19 Teeth/gum symptom/complaint^[2]


• ICD-10 Code: K08.9 Disorder of teeth and supporting structures, unspecified^[3]

Symptoms

• Toothache: Persistent or intermittent pain in the  tooth or surrounding area^[4].


• Gum swelling: Inflammation and enlargement of the gums^[5].


• Gum bleeding: Bleeding from the gums, especially during brushing or flossing^[6].


• Tooth sensitivity: Increased sensitivity to hot, cold, or sweet foods and beverages^[7].


• Bad breath: Persistent unpleasant odor from the mouth^[8].


• Loose teeth: Teeth that feel loose or shift in position^[9].


• Gum recession: Gradual loss of gum tissue, exposing the tooth roots^[10].


• Pus discharge: Presence of pus around the tooth or gums.


• Difficulty chewing or biting: Discomfort or pain while chewing or biting down.


• Jaw pain: Pain or discomfort in the jaw joint or muscles.

Causes

• Dental caries (tooth decay): Bacterial infection that causes the destruction of tooth structure.


• Gum disease (periodontal disease): Infection and inflammation of the gums and supporting structures of the teeth.


• Tooth abscess: Collection of pus within the tooth or gums.


• Tooth fracture: Breakage or cracking of the tooth structure.


• Tooth sensitivity: Exposed tooth roots or worn enamel.


• Poor oral hygiene: Inadequate brushing, flossing, and regular dental check-ups.


• Trauma or injury to the teeth or gums.


• Malocclusion (misalignment of teeth): Crowding, spacing, or bite problems.


• Bruxism (teeth grinding): Excessive clenching or grinding of teeth.


• Oral infections: Viral, bacterial, or fungal infections in the mouth.

Diagnostic Steps

Medical History

• Gather information about the patient’s dental and medical history.


• Inquire about the duration, severity, and progression of symptoms.


• Ask about any recent trauma or injury to the teeth or gums.


• Assess the patient’s oral hygiene practices.


• Identify any underlying medical conditions or medications that may contribute to dental symptoms.

Physical Examination

• Examine the teeth and gums visually for signs of decay, inflammation, or other abnormalities.


• Palpate the gums and surrounding tissues for tenderness, swelling, or abscesses.


• Check for loose teeth or abnormal tooth mobility.


• Evaluate the bite and occlusion for any misalignment or malocclusion.


• Assess the jaw joint and muscles for any signs of temporomandibular joint disorder (TMJ).

Laboratory Tests

• Complete blood count (CBC): To assess for any signs of infection or systemic inflammation.


• Oral swab culture: To identify the presence of specific bacteria or fungi causing oral infections.


• Salivary tests: To evaluate saliva composition and flow rate, which can affect oral health.

Diagnostic Imaging

• Dental X-rays: To visualize tooth decay, abscesses, fractures, or bone loss.


• Cone beam computed tomography (CBCT): 3D imaging for detailed assessment of dental and facial structures.


• Panoramic X-ray: To evaluate the overall dental and jaw structures.


• Magnetic resonance imaging (MRI): To assess the temporomandibular joint (TMJ) and surrounding structures.

Other Tests

• Periodontal probing: Measurement of pocket depths around the teeth to assess gum disease severity.


• Bite analysis: Evaluation of the bite and occlusion using articulating paper or digital sensors.


• Transillumination: Use of a light source to detect cracks or fractures in teeth.


• Biopsy: Removal of a small tissue sample for laboratory analysis in cases of suspected oral lesions or tumors.

Follow-up and Patient Education

• Schedule regular dental check-ups and cleanings.


• Educate the patient about proper oral hygiene practices, including brushing, flossing, and tongue cleaning.


• Provide instructions on diet and nutrition for optimal oral health.


• Discuss the importance of avoiding tobacco use and excessive alcohol consumption.


• Emphasize the need for prompt treatment of dental issues to prevent complications.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for teeth/gum symptoms/complaints:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Ibuprofen, Naproxen):
   
   
   
   • Cost: Generic versions can be $3-$20/month.
   
   
   • Contraindications: Active peptic ulcer disease, history of gastrointestinal bleeding, allergy to NSAIDs.
   
   
   • Side effects: Upset stomach, heartburn, increased risk of bleeding.
   
   
   • Severe side effects: Severe allergic reactions, kidney damage, liver damage.
   
   
   • Drug interactions: Blood thinners, certain blood pressure medications.
   
   
   • Warning: Prolonged use may increase the risk of cardiovascular events.
   
   
   
   


2. Antibiotics (e.g., Amoxicillin, Metronidazole):
   
   
   
   • Cost: Generic versions can be $5-$30/month.
   
   
   • Contraindications: Allergy to antibiotics, certain medical conditions.
   
   
   • Side effects: Upset stomach, diarrhea, allergic reactions.
   
   
   • Severe side effects: Severe allergic reactions, antibiotic resistance.
   
   
   • Drug interactions: Certain medications, including oral contraceptives.
   
   
   • Warning: Complete the full course of antibiotics as prescribed.
   
   
   
   


3. Topical anesthetics (e.g., Benzocaine, Lidocaine):
   
   
   
   • Cost: Varies depending on the specific product.
   
   
   • Contraindications: Allergy to local anesthetics, certain medical conditions.
   
   
   • Side effects: Temporary numbness, allergic reactions.
   
   
   • Severe side effects: Rare, but may include severe allergic reactions.
   
   
   • Drug interactions: None significant.
   
   
   • Warning: Follow the instructions for use and avoid excessive application.
   
   
   
   


4. Antifungal medications (e.g., Nystatin, Clotrimazole):
   
   
   
   • Cost: Generic versions can be $5-$20/month.
   
   
   • Contraindications: Allergy to antifungal medications, certain medical conditions.
   
   
   • Side effects: Skin irritation, allergic reactions.
   
   
   • Severe side effects: Rare, but may include severe allergic reactions.
   
   
   • Drug interactions: None significant.
   
   
   • Warning: Use as directed and complete the full course of treatment.
   
   
   
   


5. Mouth rinses (e.g., Chlorhexidine, Hydrogen peroxide):
   
   
   
   • Cost: Varies depending on the specific product.
   
   
   • Contraindications: Allergy to mouth rinse ingredients, certain medical conditions.
   
   
   • Side effects: Temporary discoloration of teeth, altered taste sensation.
   
   
   • Severe side effects: Rare, but may include severe allergic reactions.
   
   
   • Drug interactions: None significant.
   
   
   • Warning: Use as directed and avoid swallowing the rinse.
   
   
   
   

Alternative Drugs:

• Oral corticosteroids (e.g., Prednisone): Used for severe inflammation or allergic reactions.


• Antiviral medications (e.g., Acyclovir): Used for viral infections such as herpes.


• Antihistamines (e.g., Diphenhydramine): Used for allergic reactions or itching.


• Saliva substitutes (e.g., Artificial saliva): Used for dry mouth symptoms.


• Antacids (e.g., Calcium carbonate): Used for acid reflux-related symptoms.

Surgical Procedures:

• Tooth extraction: Removal of a severely decayed or damaged tooth. Cost: $75-$450 per tooth.


• Root canal therapy: Removal of infected pulp and filling of the root canal. Cost: $300-$2,000 per tooth.


• Gum surgery: Surgical procedures to treat gum disease or reshape the gums. Cost: $500-$10,000.


• Dental implants: Placement of artificial tooth roots to support dental prostheses. Cost: $1,000-$4,000 per implant.


• Orthognathic surgery: Corrective jaw surgery to address bite problems or facial deformities. Cost: $20,000-$40,000.

Alternative Interventions

• Oil pulling: Swishing oil (e.g., coconut oil) in the mouth to reduce bacteria and improve oral health. Cost: Minimal (cost of oil).


• Herbal mouth rinses: Rinsing with herbal solutions (e.g., sage, chamomile) to reduce inflammation and promote healing. Cost: Varies depending on the herbs used.


• Probiotics: Consumi