Dental Emergency, Receding Gums

Dental emergency due dental floss injury

There has been numerous reports throughout the dental literature showing how daily oral hygiene routines can cause soft tissue injury that constitute a dental emergency.  These injuries usually represent the end result of overzealous, frequently improper, use and abuse of preventive oral hygiene devices.  The interdental and papillary tissues represent areas particularly vulnerable to floss-induced injury.  Newly acquired flossing injuries usually appear as acutely inflamed, ulcerated clefts that are uncomfortable during flossing, toothbrushing, and mastication.  Histologically, clinical cleft sites generally appear as prominent focal depressions lined by stratified squamous epithelium which exhibited a thin layer of parakeratin.

Prevalence

This type of dental emergency / injury due to overzealous oral hygiene technique is extremely rare.  A study reported that out of 533 patients, only a few cases of interdental injury were attributed to dental floss or toothpicks.  Other authors have suggested that gingival irritation resulting from dental floss is not often diagnosed, but is probably common.

Contributing factors that may influence the probability and severity of flossing trauma includes tooth position, contact relationships, patient motor skills, crown-root morphology, and inter proximal-line angle.  Also, stringent plaque control demands of the Periodontist / Dentist may create a suspicion of plaque control inadequacy in the patient’s mind, frequently resulting in overcompensation.

Consequence

Tissue injury resulting from improper use of dental floss may be clinically significant for the following reasons:  1.) During vigorous flossing, increase in presence of bacteria in the patient’s blood may result.  2.) Morphology of tissue clefts may become bacteria traps and lead to inflammation and receding gums.  Treatment of this injury includes patient re-education of proper oral hygiene techniques and possible soft tissue grafting if receding gums are present.

Example

The current dental emergency demonstrates a persistent injury due to overzealous flossing technique with receding gums.  The patient’s treatment included re-education and a dermal allograft to correct the recession and inflammation.

by