Trisha E. O`Hehir, RDH
When we think of periodontal disease in kids, based on numbers alone, we first think of garden variety gingivitis and then the rare occurrence of juvenile periodontitis. However, children can develop periodontal abscesses caused by foreign objects. In my experience of working with teens and young adults, specifically dental students, popcorn hulls were the most common cause of periodontal abscesses. But with younger children, it seems that fingernail fragments are the most common cause.
College-age young people are the ones most frequently seen with a popcorn hull abscess. The localized area is generally quite swollen and often quite painful, due in part to the acute nature of the infection.
A few questions to the patient should confirm the cause. If the patient has eaten popcorn within the past week to 10 days, a popcorn hull will probably be found in the area. Popcorn hulls conform to the shape of the tooth crown, easily slipping into the sulcus. Toothbrushes, floss, and toothpicks all fail to remove the popcorn hull which seems to be attached to the tooth like a suction cup. Inflammation can be quite severe, often leading the apprehensive patient to think the tooth must be extracted. However, simply removing the popcorn hull with either an explorer or periodontal probe leads to rapid healing of the area. There is generally no need for a systemic antibiotic in treating a popcorn abscess. In some cases, before professional treatment is sought, the popcorn hull will be pushed from the sulcus by the inflammatory process.
After confirming either the presence or absence of a popcorn hull within the infected area, the patient should be reassured that healing will be forthcoming. Salt water rinses may soothe the irritated tissue and should be recommended.
During the years I worked as a clinical instructor in the Department of Periodontology at the University of Minnesota, popcorn abscesses were a weekly occurrence. The high frequency of such abscesses among college students was probably due to the popularity of popcorn as a snack. College students working at movie theaters are also likely candidates for popcorn abscesses due to their frequent popcorn consumption.
Younger children seem to have a problem with fingernail fragments. A recent article in the Journal of the American Dental Association by Dr. Curtis J. Creath reported on several cases of periodontal abscesses occurring in young children as a result of fingernail biting. The youngest was a five year old girl with swelling in the vestibular area opposite the apices of the maxillary primary central incisors. No trauma or decay were associated with the teeth and radiographs revealed nothing out of the ordinary. The little girl was put on antibiotics and referred to an oral surgeon, who extracted two teeth. Curettage of the extraction site revealed two fingernail fragments. It was suggested that the fragments had worked their way to the apices of the affected teeth.
Another case reported on the findings of six year old boy who presented with a 10 millimeter pocket on the facial aspect of a maxillary central incisor. Surgical treatment of the area revealed a total of 15 fingernail fragments as the cause of the problem.
The most recent case was a nine year old boy who had been in for his regular recall with the dental hygienist two days prior to seeing the dentist with severe tissue swelling on the facial surface of tooth number 9. As with the other cases, the clinical evaluation revealed no caries or trauma to the area. Radiographs revealed no pathology. The dentist, noticing a nail-biting habit, questioned the boy and his parents to confirm his suspicions. He used an explorer to remove a large piece of fingernail from the sulcus. Removal of the fingernail fragment led to immediate drainage of exudate and blood from the area. This infection had occurred in just two days. These cases confirm that fingernail biting can lead to periodontal problems.
Periodontal abscesses in children, teens, or young adults generally result from the presence of a foreign object in the subgingival area. First, look to see if the patent shows evidence of fingernail biting. If not, question the patient about recent popcorn eating. These are just two of the possibilities of foreign object induced abscess. But they are the two most common causes.
References available upon request from the author.
Trisha E. O`Hehir, RDH is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics.