Periodontal Abscess

Periodontal Abscess

What is Periodontal Abscess?

periodontal abscess

Introduction

Periodontal abscesses are localized purulent inflammation of the periodontal tissue

Classification Of Periodontal Abscess

A) Depending upon Periodontal Tissue involved

  1. Gingival Abscess: Gingival Abscess involves Marginal gingiva and Interdental tissue
  2. Periodontal Abscess: Periodontal abscess is an infection located contiguous to the periodontal pocket and results in destruction of periodontal ligament and alveolar bone
  3. Pericoronal Abscess: Pericoronal Abscess is associated with the crown of a partially erupted tooth

B) Depending upon the Duration

  1. Acute Abscess
  2. Chronic Abscess

Gingival Abscess

gingival abscess
  1. Gingival abscess is a localized inflammatory lesion
  2. Causes of Gingival Abscess
    • Microbial Plaque
    • Infection
    • Traumatic Injury
    • foreign body impaction (eg. dental floss, impression material )
  3. Clinical Features of Gingival Abscess - red, smooth, often painful and fluctuant swelling
  4. Treatment of Gingival Abscess
    • immediate removal of the cause
    • topical or local anaesthesia for procedural comfort
    • scaling and root planing to establish drainage
    • Surgical drainage: fluctuant area is incised with a #15 scalpel blade and exudate may be expressed by gentle digital pressure
    • Removal of foreign material
    • Irrigation of area with warm water and covered with moist gauze under light pressure
    • Patient instruction: Rinse with warm salt water every 2 hours for 1 day
    • Follow up after 1 day: Scaling

Pericoronal Abscess

pericoronal abscess
  1. Causes of Pericoronal Abscess
    • Pericoronal Abscess results from inflammation of soft tissue Operculum, which covers a partially erupted tooth
    • Risk Factor: Retention of microbial plaque, Food impaction, Trauma
  2. Treatment of Pericoronal Abscess
    • Abscess is anaesthetized for comfort
    • Drainage by gently lifting the soft tissue operculum with a periodontal probe or curette
    • Gentle irrigation with sterile saline
    • Systemic antibiotics prescribed if any systemic signs present eg. regional swelling, lymphadenopathy, fever
    • Patient instruction: Rinse with warm salt water every 2 hours for 1 day
    • Follow up after 1 day: Once acute phase is controlled
    • Operculectomy: Surgical excision of overlying tissue
    • Disimpaction

Periodontal Abscess

periodontal abscess
  1. Etiology or Risk Factor of Periodontal Abscess
    • Patients with untreated periodontitis
    • Moderate or deep periodontal pocket
    • Acute exacerbation of pre-existing pocket
    • Incomplete calculus removal
    • After periodontal surgeries
    • Systemic antibiotic therapy
    • Poorly controlled Diabetes Mellitus
  2. Clinical Feature of Periodontal Abscess

    A) Acute Abscess

    • Mild to severe discomfort
    • Localized red, ovoid swelling
    • Periodontal pocket
    • Tooth mobility
    • Tooth elevation in socket
    • Tenderness to percussion or on biting
    • Exudation or pus formation
    • Elevated temperature
    • Regional lymphadenopathy

    B) Chronic Abscess

    • No pain or dull type of pain
    • Localized inflammatory lesion
    • Slight tooth elevation
    • Intermittent exudation
    • Fistulous tract often associated with a deep periodontal pocket
    • Systemic involvement are very rare
  3. Treatment Of Periodontal Abscess
    • Drainage through pocket retraction or incision
    • Scaling and Root planing
    • Periodontal Surgery
    • Systemic Antibiotics
    • Tooth removal
    • Follow up and assessment