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Swollen Gums after Cold
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JSCowan posted:
Two weeks ago, I struggled with a nasty cold (cough, stuffy nose, sore throat) with a fever that last about four days. When the fever broke, I had five blisters on the roof of my mouth (I figured from the cough drops). I stopped taking the cough drops and eventually the cold symptoms went away. But, the sores in my mouth did not. It spread to my gums and now all my gums are swollen and bleeding. It feels like I just had my braces tightened (although I haven't worn braces in years). I'm rinsing (listerine or a 50/50 peroxide/water solution) and brushing after I eat and I'm still tongue scraping & flossing once per day (flossing hurts and bleeds). Last night I took an ibuprofen to help with the pain. These symptoms have persisted 8 days so far and while the sores on the roof of my mouth seem to be improving, my gums are not. Should I be concerned? Is there anything I should be doing? We don't have dental insurance, so I'm reluctant to see a dentist.
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Gwen Cohen Brown, DDS, FAAOMP responded:
Hi JSCowan,
Although I cannot diagnose you online what you are describing sounds a lot like a Primary Herpetic Gingivo-stomatitis. It is the initial response to exposure to the Herpes Simplex 1 (HSV1). This is NOT a sexually transmitted disease, it is the virus that causes cold sores (fever blisters, herpes labialis). Less than 10% of the population has a visible response to the to the initial exposure to the Herpes Simplex 1 virus, for most of us the response is "sub acute" meaning that your body develops immunity to the virus but you don't develop blisters.

The one diagnostic question I would ask you is if you have ever had a cold sore. If you have had a cold sore, caused by reactivation of Herpes Simplex 1 virus, then this is not the right diagnosis as you can only have a primary (initial/first) response to the virus once. This is analogous to Chicken Pox and Shingles. Since Shingles is caused by reactivation of the same Herpes virus that causes Chicken Pox you cannot have Shingles if you never had Chicken Pox.

There are very few conditions that present with blisters forming on the gums and palate, fortunately all are self limiting and although uncomfortable will go away on their own. If the blisters continue to form you should contact either your physician or dentist, both will be able to diagnose you clinically and prescribe appropriate medication.

I would strongly suggest that you stop rinsing with Listerine and/or hydrogen peroxide. Both can cause chemical burns on irritated oral tissues which may prolong your discomfort.

I hope that this helps!

Dr. Gwen Cohen Brown
 
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realtorforu replied to Gwen Cohen Brown, DDS, FAAOMP's response:
Hi Dr. Gwen,
I'm confused, I suffer from the same symptoms as the jscowen and I do not currently or have had any relationships in the last 5 years or any past cold sores.
I have blisters under my tongue and in the gums. My gums are so red and inflamed. It is so painful. I am taking antibiotic but so far nothing has helped. I too have been swishing with 50/50 peroxide and water. It burns like crazy but the soreness let's up after. I have tried salt water as well. I gave up the listerine due to the pain. I have been having ear itching and irritated throat. I had a stomach flu about a week ago and thought maybe it had something to do with it. What can I do to relieve the symptoms?? Please help..I too have no dental insurance. Thanks
 
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realtorforu replied to realtorforu's response:
Will Bonjela help?
 
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realtorforu replied to Gwen Cohen Brown, DDS, FAAOMP's response:
Ok, Well the pain became so bad that I went to the ER and was made to feel worse because they told me I had Gingivitis@!!! I knew it was not as I had a lump under my tongue and my gums were white and so sore. I wanted to scream. The doctor told me to keep taking the antibiotic and he prescribed to me the lidocaine. That there was nothing he could do.
I told my step father in PA. he sent me a medical website link and it answered my prayers to finding out what it was. I had Thrush~~~~ I immediately took a Diflucan and quit taking the antibiotic I had and it started to reverse. However, bye then I was so bad that I was taking pain meds and rinsing my mouth out with peroxide and warm salt water. I was so miserable. It is now day 4 and I am doing much better however, I still have a patch that is large but only in one spot now. I just wanted to let you know so you can maybe let patients know to check this as well. Please notify people of this possibility.
 
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Gwen Cohen Brown, DDS, FAAOMP replied to realtorforu's response:
Hi Realtoforu,

I hope you are feeling better and that your mouth is back to normal.

I am not sure what the timeline is between when this first started and now. This is an important piece of information as it will change the clinical diagnosis.

Primary herpetic gingivostomatitis typically lasts up to but not past 21 - 25 days. This is from first blister to completely healed. If you are healthy and it has been much longer than three weeks we are not dealing with a case of primary herpetic gingivostomatitis.

Patients with Primary herpetic gingivostomatitis do not typically develop swellings under the tongue however, lymph nodes are often found under the tongue and if you have had an active infection over a period of time these lymph nodes will be swollen. Remember that infections drain to the nearest lymph node.

Rinsing with peroxide is not a good idea, you are likely to give your self a chemical burn. It may stop the discomfort however that is most likely a result of the peroxide killing the peripheral nerves endings in your mouth. Alcohol based mouth rinses, peroxide, topical gels or solutions may stop the pain temporarily but they are not a long term solution.

I do not know if Bonjela will or will not be effective. Bonjela works as a keratolytic (breaks down cells containing keratin) and contains salicylic acid, the main ingredient in aspirin. So Bonjela seems to work the same way that other topical OTC agents work, the pain is reduced because the peripheral nerve endings have been destroyed by a chemical burn.

The topical OTC preparations you can purchase at a pharmacy without a prescription work through a combination of a numbing agent and superficial chemical burn. Misuse will result in delayed healing and possible death of the oral mucosa and subsequent sloughing (peeling) of the oral mucosa.

The Diflucan, while effective, should only be used under a doctors supervision with a confirmed diagnosis. There are many types of oral candidiasis and the acute pseudomembranous type (thrush) is a common complaint of people taking antibiotics. The antibiotic kills all the bacteria, not just the bad ones, and this imbalance in the mouth will allow the fungal (yeast) organisms to flourish.

Candida is a normal part of your oral flora, it is supposed to be in your mouth. Without it you would have an overgrowth of microbial and bacterial organisms.

However, having said this, it is most likely that the overgrowth of candida in your mouth was a direct result of the antibiotics and is not the truly related to the problem on your gingiva.

Gingivitis is not typically treated by oral antibiotics unless it has become secondarily infected. This is a judgement call and can only be done after seeing the patient clinically. Lidocaine can help ease the discomfort however it is not treating the etiology of the problem, it just treats the symptoms. I occasionally prescribe viscous lidocaine and many people find it quite effective for temporary pain management.

I am happy to hear you are feeling better and strongly suggest that you take the time to see your dentist to have an assessment of your oral health. Be sure to tell them everything - duration of symptoms, clinical presentation, medications prescribed an taken as well as any topical OTC regimens.

The best advice I can give you is to see a clinician knowledgeable in the field of oral medicine or clinical oral pathology.

I hope this helps!

Dr. Gwen Cohen Brown


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