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Gwen Cohen Brown, DDS, FAAOMP

Joined: 06/15/2011

Expert Profile:

Dr. Gwen Cohen Brown is an Associate Professor in the department of Dental Hygiene at the New York City College of Technology, and is a Fellow in the Academy of Oral and Maxillofacial Pathology. Dr. Brown graduated with a Doctor in Dental Surgery (D.D.S.) degree from The New York University College of Dentistry (NYUCD) in 1988 followed by an Advanced Education Program in General Practice Dentistry also at NYUCD. She completed a three-year residency program in Oral and Maxillo-Facial Pathology at the New York Hospital Medical Center of Queens and continued her education in a two-year sub-specialty fellowship in Oral and Maxillo-Facial Pathology at the Health Science Center S.U.N.Y. Brooklyn Downstate Medical College/Kings County Hospital Medical Facility.

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Reply: Was it an Abcess or did I unknowingly burn the roo...

Hi strshne_420, Unfortunately I am not able to diagnose on line and...

Posted by Gwen Cohen Brown, DDS, FAAOMP

1 Reply | Reply | Watch This DiscussionReport This| Share this:Was it an Abcess or did I unknowingly burn the roof of my mouth? Hi strshne_420, Unfortunately I am not able to diagnose on line and...

Reply: Swollen Gums after Cold

Hi Realtoforu, I hope you are feeling better and that your mouth is...

Posted by Gwen Cohen Brown, DDS, FAAOMP

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 BrownView Thread

Posted byGwen Cohen Brown, DDS, FAAOMP

5 Replies | Reply | Watch This DiscussionReport This| Share this:Swollen Gums after Cold Hi Realtoforu, I hope you are feeling better and that your mouth is...

Reply: Raw patch in my mouth

Hi Kaelaleman, Although I am not allowed to diagnose on line my...

Posted by Gwen Cohen Brown, DDS, FAAOMP

1 Reply | Reply | Watch This DiscussionReport This| Share this:Raw patch in my mouth Hi Kaelaleman, Although I am not allowed to diagnose on line my...

Reply: Sores in my mouth

Hi Asimon, I am sorry you have been uncomfortable and hope it is...

Posted by Gwen Cohen Brown, DDS, FAAOMP

1 Reply | Reply | Watch This DiscussionReport This| Share this:Sores in my mouth Hi Asimon, I am sorry you have been uncomfortable and hope it is...

Reply: Mouth feels raw & tongue burning.

Hi Klesterr, Hopefully you are feeling better by now. The tissue...

Posted by Gwen Cohen Brown, DDS, FAAOMP

2 Replies | Reply | Watch This DiscussionReport This| Share this:Mouth feels raw & tongue burning. Hi Klesterr, Hopefully you are feeling better by now. The tissue...

Reply: Red Strip on Tongue

Hi Maman, Unfortunately I cannot diagnose online and would need more...

Posted by Gwen Cohen Brown, DDS, FAAOMP

3 Replies | Reply | Watch This DiscussionReport This| Share this:Red Strip on Tongue Hi Maman, Unfortunately I cannot diagnose online and would need more...

Reply: strange thing on my top gum

Hi horizondestruct, Although I cannot diagnose online I can tell you...

Posted by Gwen Cohen Brown, DDS, FAAOMP

1 Reply | Reply | Watch This DiscussionReport This| Share this:strange thing on my top gum Hi horizondestruct, Although I cannot diagnose online I can tell you...

Reply: Blood pressure meds and gum problems

Hi An_248325, While there is a known response to blood pressure...

Posted by Gwen Cohen Brown, DDS, FAAOMP

Hi An_248325, While there is a known response to blood pressure medication it does not develop in every patient. Gingival (gum) overgrowth has occured in patients taking beta blockers and ACE inhibitors as well as numerous other drugs that are not used for regulating blood pressure.

The good - or bad - news is that ginival overgrowth does not develop in all patients taking these medications, however, if gingival overgrowth does develop as a result of the blood pressure medication it can be difficult to treat and you will need to have your physician and dentist work together. There are two separate issues that need to be addressed.

You need to know that the gingival overgrowth is neither dose or time related, in other words if you are going to develop gingival overgrowth secondary to a specific medication - because you are susceptible - you are going to get it and it does not matter how long you have been taking the medication or what dose (size of pill) the pill is.

The other issue is that once you have developed gingival overgrowth to one beta blocker the likelihood is that all beta blockers will result in gingival over growth. The same goes for ACE inhibitors, if you develop a gingival overgrowth to one ACE inhibitor chances are the entire category of medication will cause you to develop gingival overgrowth. So if you are taking a beta blocker to treat your high blood pressure you cant switch to a different beta blocker as all of the beta blockers will cause you to develop gingival overgrowth. The same goes for the ACE inhibitors.

As you can imagine this presents problems for the patients cardiac care. If the only medication that is effective in treating a patients high blood pressure is a beta blocker and beta blockers cause that specific patient to develop gingival overgrowth the regulation of blood pressure trumps the gum disease. If the patient can be treated with a different classification of high blood pressure medication then great, switch the classification of medication, the gingival overgrowth will need to be treated but should not recur with the new medication, so if you are on beta blockers and you develop gingival overgrowth you can switch to an ACE inhibitor and visa versa.

If you can't switch to a new blood pressure medication in a different classification you must understand that the gum tissue will continue to grow as long as you are taking that specific medication to treat the high blood pressure.

Either way you will need to treat the gingival overgrowth as it will not go away on its own. Your dentist or periodontist (gum specialist) will need to remove the gingival overgrowth. Once it is healed you will need to maintain scrupulous oral hygiene and ideally you should see a dental hygienist three to four times a year. This is the only way to prevent bone loss in under the affected gingiva and subsequent loss of teeth.

I realize that this is a very long answer to a very short question, however it is complicated. The main thing to remember is this; your heart health is more important than your oral health and which ever high blood pressure medication is the most effective for you is the one you should use. Any oral problems that develop as a result of the medication can be treated by your dentist and dental hygienist.

I hope this helps. Let me know if you have additional questions.

Dr. Gwen Cohen BrownView Thread

Posted byGwen Cohen Brown, DDS, FAAOMP

1 Reply | Reply | Watch This DiscussionReport This| Share this:Blood pressure meds and gum problems Hi An_248325, While there is a known response to blood pressure...

Reply: *Ripped Gum*

Hi HollyKay100, Sorry to hear you have been having pain, hopefully...

Posted by Gwen Cohen Brown, DDS, FAAOMP

1 Reply | Reply | Watch This DiscussionReport This| Share this:*Ripped Gum* Hi HollyKay100, Sorry to hear you have been having pain, hopefully...

Reply: Gum or teeth tighening

Hi An_247521, I am sorry to hear you have been having pain. Although...

Posted by Gwen Cohen Brown, DDS, FAAOMP

4 Replies | Reply | Watch This DiscussionReport This| Share this:Gum or teeth tighening Hi An_247521, I am sorry to hear you have been having pain. Although...

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