October 29, 2023
In Greek, 'para' means beside or nearby, and 'oula' means the gums. A 'parulis' is thus a lesion of the oral cavity that is appreciated on the gingiva (gums) of the tooth. It appears similar to a boil on the skin and hence is also known as gumboil. A parulis usually indicates a long-standing infection of the associated tooth and is formed as a result of the body's defensive response to an irritant or infective agent.
How does a parulis get formed?
A parulis is formed at a much later chain of events that follow when a tooth becomes infected. Infection of the tooth can arise because of bacteria, previous faulty restorations (fillings) or trauma. A tooth is said to be infected when the presence of caries (decay) can be appreciated on its surface. These act as gates for the bacteria to further penetrate the tooth.
When the infection reaches the core of the tooth (pulp), the microbes begin to degrade the blood vessels and nerves within the tooth. This triggers the pain response. However, if ignored, the nerves will eventually die, thereby leading to cessation of pain. This however does not mean that the infection is over. In fact, it indicates a worse condition, where there will now be a collection of infective material located at the base of the affected tooth's roots.
At this stage, there will be a mass of an infective fluid-filled tissue. This is called an abscess. A stage comes when the pus collection intensifies to an extent that it begins to search for its way out of the confines of the soft tissue associated with the now non-vital (lack of blood vessels and nerves) tooth. This leads to the formation of a tract. This tract begins from the base of the tooth's apex till its way out through the associated gingiva.
In the process of the formation of a sinus tract, the body sends white bloods cells in the area of the pus as an attempt to fend off the infection. This leads to the formation of granulation tissue around the pus. The granulation tissue is nothing but the formation of new tissue following an injury or infection. Clinically, this situation is presented as a reddish or yellowish spot surrounded by the inflamed tissue. This inflamed tissue is nothing but the granulation tissue itself. The lesion nearly resembles an ulcer or a boil. This is called a parulis.
Symptoms when having a parulis
A gumboil or parulis can radiate mild to moderate levels of pain. Upon squeezing the soft tissue, the oozing of pus can also be appreciated. The gumboil may also bleed profusely.
Gum boil or Parulis treatment
The dentist first confirms that the soft tissue swelling presented as a gum boil is associated with the tooth. Radiographs (x-rays) are usually taken to confirm this. Dentists may also use soft, thin, slender sticks known as gutta-percha points for further confirmation. The gutta-percha points are introduced in the opening of the parulis and a radiograph is taken which reveals the path of the gutta-percha point.
In order to treat a parulis, the abscess needs to be relieved and the source of the infection needs to be eliminated. The abscess is usually drained by puncturing the abscess that causes the pus to drain. However, this is not a permanent solution as the source of infection is yet to be removed.
A non-vital tooth usually calls for a root canal treatment. More extensive treatments like tooth extraction is only opted for in cases where the roots are severely resorbed (eaten away) and the prognosis is hopeless. A root canal treatment includes cleaning, disinfecting and debriding the tooth's roots and thereby removing the infected material. Patients are usually kept on an antibiotic regime which further accelerates the resolution of the infection.
Home remedies for gum parulis
Home remedies for parulis are only temporarily effective. The usage of clove oil over the parulis or rinsing the area with warm salt water are some of the commonly employed techniques. However, this shall by no means be definitive treatments. They are only temporary relievers and a visit to the dentist is mandatory. Since a parulis can spread and infect the underlying jaw bone, there should be absolutely no delay in its treatment.