If drainage does not occur, have the patient rinse with warm saline solution for 10 minutes every 2 hours.  This  should  help  promote  drainage. NOTE: NEVER apply heat to the external surfaces of the face. If drainage still does not occur, apply an ice pack to  the  affected  area.  This  may  reduce  the patient’s  discomfort  until  the  dentist  can  provide emergency treatment. When drainage is established, give the patient instructions about home care and notify the dental  officer  to  see  if  a  prescription  for antibiotics can be called in to the pharmacy. Instruct  the  patient  to  return  to  the  dental treatment facility (DTF) for definitive treatment as soon as possible. DISEASES OF THE PERIODONTAL TISSUES Most periodontal diseases result in the gradual recession of the tissues of the periodontium. If the disease process is not stopped, it may progress to the harder, bony tissues of the alveolar ridge and lead to the loss of teeth. MARGINAL  GINGIVITIS Gingivitis  is  an  inflammation  of  the  gingival tissue.   Marginal   gingivitis   is   a   relatively   mild inflammation of the borders of the gingival tissue. Sometimes, the inflammation is localized; it may exist around one, two, or a group of teeth. If the condition is generalized, then it will exist around all the teeth. The most  frequent  cause  of  marginal  gingivitis  is  the presence of bacterial plaque buildup due to lack of adequate oral hygiene. Symptoms A  patient  with  acute  gingivitis  may  complain  of the following: Sore or swollen gums Bleeding gums Signs Upon   examination   for   gingivitis,   you   may observe: A  painful  reaction  or  gingival  bleeding  when finger pressure is applied Red, swollen gingiva with a loss of stippling Heavy  plaque  and  calculus  deposits  in  the affected area Treatment To treat marginal gingivitis, include the following in the emergency treatment plan: Perform the emergency treatment guidelines. Give the patient oral hygiene instructions; refer to Dental Technician, Volume 2, NAVEDTRA 12573, chapter 3, “Preventive Dentistry.” Have  the  patient  rinse  with  a  warm  saline solution. Gently scale the teeth to remove soft debris and any obvious supragingival calculus. NECROTIZING ULCERATIVE GINGIVITIS Necrotizing  ulcerative  gingivitis  (NUG)  is  a severe infection of the gingival tissue, commonly referred  to  as  trenchmouth.  It  may  result  from untreated marginal gingivitis, poor dietary habits, smoking or alcohol consumption, a rundown physical condition of the patient, or a combination of these factors. Symptoms A patient may present the following symptoms when NUG is present: The  same  symptoms  as  that  of  marginal gingivitis A bad taste in the mouth Pain when eating or brushing Excessive  bleeding Signs Upon examination for acute gingivitis, you may observe the following signs of NUG: Same as those of marginal gingivitis, but more severe. Heavy plaque and calculus deposits. Ulceration  and  cratering  of  the  interdental papillae. Frequently, so much of the papillae is lost that the triangular area between the crowns of the teeth present a “punched out” appearance. A gray-white membrane covering the gingiva. A foul odor from the oral cavity. Pus oozing from the gingiva. Areas of gingival recession. 6-4