Cones on the gums: what to do, how to treat?

A bump on the gum is an unpleasant symptom that can accompany many dental diseases. It should be noted right away that the "cone on the gum" is a rather abstract and simplistic concept. This term is used only to describe the clinical picture of the disease and is prevalent mainly in the common people. Depending on the specific pathology, the cone on the gum will have a specific scientific name.

[1], [2], [3]

Causes of the bumps on the gum

The causes of cones on the gums may be very different. Since this symptom can occur with dental diseases of different groups (dental disease, periodontal disease, mucous membranes), then it is worth considering each pathology separately. It will be rational to start with the most common diseases and finish more sparse. So, the main reasons for the appearance of cones on the gums are: cyst, hematoma, exostoses, periostitis, hypertrophic gingivitis, benign and malignant soft tissue tumors.

[4], [5]

Cyst

Many inflammatory processes that occur in the ligamentous apparatus of the tooth may be accompanied by the appearance of a cone in the gum. One of the striking examples is the formation and suppuration of the radicular cyst. The pathogenesis of this phenomenon can be described in many ways. For example, a person has a carious lesion of the tooth. Then this process causes inflammation of the pulp, which subsequently provokes the onset of periodontitis. Inflammation of the ligamentous apparatus of the tooth can be acute or primarily chronic (when a chronic course occurs at once). An acute inflammatory process often immediately causes a person to turn to a specialist. However, the primary chronic periodontitis is asymptomatic, which does not create any reason for a visit to the doctor. Thus, around the root of the tooth is formed granuloma, which contains a dense epithelial capsule and liquid contents. Another pathogenetic mechanism can be a trauma to the tooth followed by the development of traumatic periodontitis and the transition of inflammation to a chronic form. It is also worth noting arsenic and toxic periodontitis, which arise as a result of complications of endodontic treatment. All these situations eventually lead to the formation of granulomas. If the tooth does not exacerbate periodontitis, the formation around the root of the tooth gradually increases. Reaching a diameter of 0.5 cm, the granuloma passes to the stage of cystogranuloma. When the size exceeds 0.8 cm, then we are talking about a cyst. Interestingly, even with a size of about 3 cm or more, a person may not feel any symptoms. Although some people have certain symptoms: increased sensitivity when biting on the tooth, discomfort in one or more teeth, displacement of teeth for no apparent reason (in advanced stages).

All symptoms of the cyst are absent or manifest "blurry" only until its suppuration occurs. When the cyst is suppurated, the serous contents turn into a purulent exudate. And, as you know, any purulent processes in the body proceed with a rather vivid symptomatology. It is at this stage of the disease that a person can clearly see that a lump has appeared on the gum. Its formation is due to the fact that pus, which is in the cystic cavity, tends to go outside. As a result, a fistulous canal is formed, which emerges in the gum area and creates a cone with pus on it. In addition to this symptom, the general condition of the body worsens, symptoms of intoxication appear, body temperature rises, lymph nodes may increase.

Earlier we spoke of radicular cysts, which are most often the result of chronic granulomatous periodontitis. However, in addition to it there is also a granulating form. The peculiarity of this disease is that when exacerbation on the gums opens a fistulous course. Clinically, the person concerned is not passing pain in the tooth, which increases at the moment of nibbling. With any touch to the causative tooth, there is a sharp pain that can not be tolerated. In some situations, the pus between the tooth and the gum periodically results in pus. The gums in the periodontitis tooth region are bright red, painful on palpation. In the projection of the root of the tooth on the gums can be observed fistula with a diameter of several millimeters to a centimeter. He looks like a white cone on the gum, which is above the tooth. The mechanism of its formation is the same as with suppuration of the cyst: pus tends to go into the open environment and moves along the path of least resistance. As a result, when purulent masses pass through the bone, they collide with the elastic mucosa. This leads to a cone growing on the gum. It is logical to assume that the pressure of pus on the mucosa should cause severe pain. However, with periodontitis, the pain in the tooth is much stronger than in the gum. Therefore, patients often only note the presence of cones, and the pain is characterized as dental.

[6], [7], [8]

Hematoma

When performing anesthesia, there are times when the needle penetrates the venous vessel. This may be due to both the individual anatomy of the cardiovascular system and the wrong choice of the needle to perform anesthesia. On the gum, the hematoma may appear after the infiltration anesthesia has been performed. Clinically, it manifests itself as a cone of dark blue or black. In the dentist's office, a person does not pay attention to the presence of a hematoma. This is due to the fact that the anesthetic blocks the pain, thereby smoothing the symptoms of the hematoma. And already after leaving the dentist the patient can realize that, for example, after removing the tooth, he had a lump on the gum. Just say that you should not pierce the vial. If this is done, then at the site of the cone a wound is formed, into which the infection can get. The hematoma on the gum passes on its own and does not leave any consequences after itself.

Sometimes hematomas appear in children with teething teeth. In this case, you should consult a pediatric stomatologist for the doctor to have an examination. On the basis of the data obtained, the specialist will decide whether it is necessary to create additional conditions for teething or the child's body will cope with this task independently.

Exostoses

Exostoses are bone protuberances on the jaw, which visually and palpation resemble a lump. The causes of exostoses are not fully understood, however, the main risk factor is the absence of a large number of teeth. The fact is that with the loss of teeth, the jawbone in the toothless area begins to atrophy. This process is due to the fact that the bone tissue of the human body is designed to absorb the load. And, if the physical load does not come, then the corresponding bone zone simply resolves. It should be noted that in every person the mechanisms of bone formation and destruction occur with individual characteristics. Therefore, in some parts of the bone continues to exist, and in some - atrophy. The remaining fragments of bone can have different shapes and sizes. Often exostoses have a triangular, oval or spiny shape. However, regardless of the shape of the bone, it seems to the person that he has a solid cone on his gum. As a rule, it does not hurt, does not increase in size. From the side of the mucous membrane, no changes are observed either. The gums have a pale pink color and a normal relief that resembles the texture of a lemon peel. And everything would be fine, but problems appear when a person starts using a removable plate prosthesis. If during the manufacture of the prosthesis the doctor did not take into account the presence of exostoses, then subsequently problems with fixation of the basis may start. In this case, the person will stop using the prosthesis and all efforts of the doctor and the patient will be meaningless.

[9], [10]

Periostitis (flux)

Periostitis is a disease in which the inflammatory process is localized in the periosteum. Most often the main factor of the disease is pulpitis or periodontitis. The first signs of periostitis are a slight swelling in the gum area. Gradually, the swelling grows and pain appears, which is characterized by the spread of pain to the temporal, orbital, parietal and other areas. As a rule, the general condition of the body deteriorates significantly: weakness, headache, body temperature rises to 38 ° C. In some cases, with a periostitis, a fistula appears on the gum. As mentioned earlier, outwardly it looks like a bump on the gum. 

Hypertrophic gingivitis

Hypertrophic gingivitis (hypertrophy - "proliferation, gingivitis -" gum disease ") is an inflammatory disease of the gum, which is accompanied by the proliferation of its soft tissues. The causes of this disease are described rather abstractly. Great importance in the origin of pathology is attached to the disruption of the endocrine system. Also, hypertrophic gingivitis can occur during hormonal changes, which are physiological processes. For example, in adolescents, hormones are actively released during puberty. Also important is the menstrual cycle in women and the period of pregnancy. All these conditions seriously affect the fragile system of hormones. The risk factors for this disease are the following: taking hormonal drugs, the period of physiological hormonal bursts, the endocrine system. The clinical picture of hypertrophic gingivitis is quite bright. The gums turn red, swollen. There are sprouting gingival papillae, which resemble cones between the teeth. A person feels itching and tingling in the gums, an unpleasant aftertaste in the mouth and an increase in the viscosity of saliva. Diagnosis of the actual gingival hypertrophy is very simple. The clinical picture speaks for itself. However, to identify the cause of this condition, you may need a comprehensive examination of the body.

Benign tumors

Cones on the gums sometimes are tumors of a benign nature. Among this group of pathologies, papilloma and fibroma are most common. They can appear in people of any age and sex. Predisposing factors are stress, chronic mucosal trauma, systemic diseases, hereditary predisposition.

Papilloma is the growth of the papillary layer of the dermis. This new growth is growing quite slowly (for several months), but under certain conditions (reduced immunity, stressful situations, systemic diseases), papillomas can accelerate their growth while remaining a benign tumor. Clinically, papilloma proliferation looks like a soft smooth cone on the gums of pink or white, located on a thin stalk. It does not hurt and can not cause significant discomfort. However, over time, a person can notice that the bump on the gum grows. And in this case, you can not remain indifferent to this phenomenon. You should consult your doctor and perform all required tests.

Fibroma is a benign tumor that consists of connective tissue fibers. Outwardly, it resembles the papilloma, but it has a broad base and a tuberous surface, which distinguishes it from the tumor examined earlier. In general, the fibroid has the same growth pattern as the papilloma.

[11], [12], [13], [14], [15]

Diagnostics of the bumps on the gum

Diagnosis of cysts in the early stages is very difficult. This is due to the absence of symptoms that can cause a person to go to the doctor. Therefore, cysts are most often detected accidentally when performing a sighting or panoramic radiography. The only "positive" property of the cyst is that it appears clearly on the roentgenogram. This allows the doctor to see its boundaries and understand how much surgery will be required.

Diagnosis of exacerbation of chronic granulating periodontitis is often not difficult for the clinician. Complaints of the patient for pain with nipping suggest that it is likely to be a periodontitis. If the tooth was previously treated, then we can talk about the aggravation of the inflammatory process. Since the tooth is aching and there is a lump on the gum, the person has a granulating inflammation of the ligamentous apparatus of the tooth. The diagnosis is confirmed by radiographic data. In the picture, in the region of the apex of the root, a region of darkening of the bone is determined in the form of "flame tongues" without distinct contours. This indicates a resorption of bone tissue in the focus of a granulating infection. During the clinical examination, differential diagnosis should be performed with suppuration of the cyst. However, this task is also solved using an analysis of the X-ray image.

Diagnosis of exostoses does not cause problems. The diagnosis does not require any analysis and laboratory diagnosis. To clarify the situation, only a clinical examination is sufficient. Most often, bone formations appear in people of mature and advanced age with a partial or complete adentia. Bone projections are formed rather slowly, because the processes of atrophy occur for several years. Also in favor of exostoses is the normal state of the mucous membrane.

For diagnosis of periostitis, a clinical examination is sufficient. The doctor diagnoses and chooses the treatment. 

Tumors are diagnosed only with the help of laboratory tests. Clinical instrumental diagnosis is only preliminary and does not carry a definitive diagnostic value. Therefore, histological and cytological studies are performed. If there is a suspicion of malignancy, then the "histology" of the material is more often performed. The preparation evaluates the nature of tissue growth (benign or malignant). If there is no suspicion of malignancy, then cytological research is performed. Under the microscope, the pathologist examines the integrity, condition of the organelles and the maturity of the cells.

[16], [17], [18], [19]

Treatment of the bumps on the gum

To date, there are two types of treatment for cysts, and both are surgical. The first method is cystotomy. This method is more conservative, it involves the creation of fluid outflow from the cystic cavity. As a result of reducing the pressure in the cavity, the cysted tissue will begin to return to its original position. For this, a channel is formed surgically by which the exudate will be drained from the cyst. To ensure that the created channel does not overgrow, a special obturator is implanted into it. The method of cystotomy is used only for large cystic cavities, which threaten the integrity of the jaw bones. In other cases, this approach is not recommended. Firstly, a cyst reduction can last up to one year, and this involves finding the obturator in the oral cavity throughout the duration of the treatment. Secondly, the growth of the cyst can recur at any time, which makes the entire therapeutic process inconclusive. It is also worth noting that in order to avoid relapse, cystectomy is required anyway. Therefore, in most clinical situations, a cystectomy surgery is performed.

Cystectomy - complete removal of the cystic cavity surgically. When this intervention is performed, the contents of the cyst are completely extracted, together with its envelope. It is very important that surgeons leave not the slightest part of the tumor in the bone. If this happens, then the development of the cyst can continue. The ideal option is to extract the cyst without damaging its shell. In this case, you can be completely sure that there are no pathological tissues in the bone. Also, with cystectomy, resection of the apex of the root of the causative tooth is performed. Simply put, the apex of the root of the tooth is cut and the cavity formed is filled with artificial bone material. As a result, after a qualitative surgical intervention, the lump on the gum disappears, the integrity of the bone remains preserved, and the prognosis for recovery is favorable.

Treatment of exacerbation of granulating periodontitis is a complex test for both the doctor and the patient. The course of therapy can last several months or even a year. The entire period of treatment requires a clear implementation of all the doctor's instructions. Statistics show that 70% of people under the age of 40 lost at least one tooth due to inflammatory processes in periodontics. Most of these people later turned to the doctor or neglected the recommendations of the dentist during the therapy. From this it is necessary to draw a conclusion that the preservation of the tooth is the goal to which it is necessary to go along with the doctor.

If a lump on the gum appeared in the person and a diagnosis of exacerbation of chronic granulating periodontitis was diagnosed in the doctor's office, the dentist should first open the tooth in order to create access to the canals. Unfortunately, in the course of this process, the fillings and crowns that cover the tooth will be removed. It should immediately be said that to remove the crown carefully and after treatment to fix it again on the tooth will not work. This can lead to the ingress of fluid between the crown and teeth, which will lead to the destruction of the tooth or exacerbation of periodontitis. After opening the tooth, the doctor cleans the canals and removes the filling material from them. Here it should be noted that cleaning previously sealed channels is a very complicated process. You need to be prepared for the doctor to work with the channels for several hours. And if the specialist manages to cope faster, then let it be a pleasant surprise for you. After cleaning the canals they are repeatedly washed with various antiseptics. However strange it may sound, the main focus of infection is in the canals of the tooth, and not in the periodontium. Therefore, qualitative treatment of root canals is an important stage in the treatment of periodontitis. When the channels are prepared, they are injected with antibacterial and anti-inflammatory pastes. After that, the tooth is closed with a temporary filling. The next visit comes in 3-6 days. The tooth is reopened, the channels are rinsed again, and this time, substances introduced into the root canals that stimulate the regeneration of bone tissue. This is necessary in order to eliminate the focus of bone resorption. After that, the tooth is again closed with a temporary filling and waiting for the next visit, which will take about a week. The last stage is repeated a large number of times. If there is a positive dynamics, then on the roentgenogram the focus of the blackout of the bone will gradually decrease. This will indicate that the treatment technique is effective and therapy must be continued. When the bone in the image acquires the desired density and texture, it can be said that the tooth treatment is completed. It is worth noting that here is a classic example of the treatment of periodontitis. To date, there are many effective methods. Therefore, the therapeutic method suggested by your doctor may differ from the one given in the article, but it can be quite acceptable.

Treatment of exostoses is not always required. The fact is that bone surgery is always a serious surgical intervention. And, given the fact that most patients with exostoses are people aged 50 years and older, one should think about the advisability of this kind of intervention. Therefore, if the exostoses do not create obstacles for fixing the prosthesis, they can not be operated. It is recommended only to make such a prosthesis that will not rest against bone protrusions or will have a soft lining. Sometimes the size and shape of exostoses do not allow to achieve the optimal result of a removable prosthesis, which requires an alveollectomy. This operation consists of several stages. The first is local anesthesia. The second - delamination of the mucous membrane of the gum. The third is the preparation of the bone protrusion with the help of burs. Fourth - putting the flap in place and suturing the wound. This operation is very effective, however, the age of many patients is the reason for refusing surgery. On the other hand, chewing function should be present at any age. So, you need to look for a way to restore the dentition. Implantation, alveollectomy, prostheses with holes for exostoses, prostheses with soft lining, elastic prostheses are all solutions to one problem, and which one to choose, should be solved together with the doctor in the dental office.

There is a conservative and surgical treatment for periostitis. Conservative treatment involves the use of anti-inflammatory drugs, antibiotics to eliminate purulent process. With the surgical method, the doctor makes a cut in the area of the inflammation focus, flushes and drains the wound. What method of treatment to choose, solves only a qualified specialist.

Treatment of hypertrophic gingivitis should be directly related to factors that provoke the appearance of this condition. This is a very important point that must be realized before trying to cure bumps on the gums with hypertrophic gingivitis. For example, during pregnancy, drug treatment of this condition is strongly undesirable. The fact is that in this situation, gingival hypertrophy is caused by hormonal changes that always accompany the course of pregnancy. Therefore, the use of medicines may have a toxic effect or disrupt the hormonal background, which can lead to serious consequences.

In adolescence, also medical treatment of hypertrophic gingivitis is not shown. This, again, is due to the fact that hormonal bursts at this age speak of a normal and timely development of the body. Therefore, only the following questions remain: "Than to rinse?", "How to gnaw the gums?", "When will the cones on the gums"? "Since there is an inflammatory component in the course of hypertrophic gingivitis, it is recommended to use herbal medicines that have antiseptic and anti-inflammatory properties . You can also use rinsers and toothpastes containing medicinal herbs. Speaking succinctly, the basis of treatment is optimal hygiene of the oral cavity and phytotherapy.

In some cases, however, medical intervention is required. However, the main role in this case is played not by the dentist, but by the endocrinologist. If a person has a hormonal imbalance, then the specialist should determine the cause of this condition and make a plan for hormonocorrection. If treatment with the endocrinologist was started before the appearance of cones on the gum, it is quite possible that some of the hormonal drugs provoked gingivitis. In this case, the question of whether it is possible to cancel the causal drug or whether it is necessary to take it further. In any case, the dentist in such a situation conducts only symptomatic treatment. He appoints rinses, applications of medicinal ointments, physiotherapeutic treatment and sclerosing therapy.

Treatment of cones on the gums, which is papilloma or fibroma is carried out by various methods. The classic method is surgical excision of altered tissues. The operation is performed under local anesthesia. The surgeon gently removes the tumor and sutures the wound.

There is also a method of cryodestruction. It involves removing the tumor with liquid nitrogen. This method is longer than classical surgery, as it involves several visits. That is, cryodestruction provides a course of treatment in which the tumor is gradually "burned" with liquid nitrogen.

Another effective method is radiosurgery. Using this method, it is possible to point irradiate the lump on the gum. For this purpose, a special apparatus is used which is the source of ionizing radiation. The procedure is performed only once and after that the quality of treatment of the cones on the gum is evaluated.

It is worth paying attention to this method of tumor removal, like electrocoagulation. The procedure involves the effect of high temperature on the papilloma or fibroids. A special coagulator is used for this. Outwardly, it resembles an ordinary soldering iron, which cauterizes the tumor.

The latest and rapidly growing popularity method is laser surgery. Removing a tumor with a laser is an extremely accurate, low-invasive, painless and bloodless operation. This method shows excellent long-term results. However, the laser installation is an expensive equipment that requires financial justification. Therefore laser operations are considered to be the most expensive and difficult to reach for the population.

Prevention

The approach to prevention of cones on the gums should be complex. Therefore, precautions should be aimed at preventing the emergence of all considered diseases.

As for the prevention of the appearance of a cyst, this task is rather complicated. First, all mechanisms of the origin of the cystic cavity have not been fully studied. Secondly, the growth of this education is rarely accompanied by any symptoms. Thirdly, people in exceptional cases perform radiographic examination of teeth without a good reason. Therefore, the only way to avoid the appearance of cysts is to exclude those factors, the negative impact of which has been scientifically proven. Therefore, tooth injuries should be avoided and caries, pulpitis and acute periodontitis should be treated in a timely manner. This avoids the appearance of foci of chronic infection in periapical tissues.

Prophylaxis of cones in hypertrophic gingivitis can be performed only by maintaining a healthy lifestyle. Also it should be noted that one should not take hormonal preparations without the doctor's prescription.

Papillomas and fibromas have very abstract data about their origin. Therefore, recommendations for the prevention of these pathologies will be the same as for other considered diseases.

Unfortunately, it is not possible to avoid occurrence of the listed diseases. Even with the implementation of all recommendations, the probability of occurrence of the examined pathologies still remains. This is due to the fact that we can not exclude some of the risk factors from our lives. Genetics, the ecological situation, the impact of radio waves - all this has not yet been fully controlled. Therefore, it remains only to maintain a healthy lifestyle, improve their material and spiritual well-being, live positively and believe in the best.

[20], [21], [22], [23], [24], [25]