Periodontal Abscess

Periodontal AbscessDr. Ahmed TawfigDr. Ghousia Sayeed

What is periodontal abscessThe periodontal abscess is a localized purulent inflammation of the periodontal tissues

Classification of periodontal abscessAbscess have been classified into three diagnostic groups: Gingival abscess, Periodontal abscess, and Pericoronal abscess. The gingival abscess involves the marginal gingival and interdental tissues. The periodontal abscess is an infection located contiguous to the periodontal pocket and may result in destruction of the periodontal ligament and alveolar bone. The pericoronal abscess is associated with the crown of a partially erupted tooth.Periodontal AbscessThe periodontal abscess is typically found in patients with untreated periodontitis and in association with moderate-to-deep periodontal pockets.Periodontal abscesses often arise as an acute exacerbation of a preexisting pocket.

Periodontal AbscessPrimarily related to incomplete calculus removal, periodontal abscesses have been linked to a number of clinical situations.They have been identified in patients after periodontal surgery, after preventive maintenance after systemic antibiotic therapy, and as the result of recurrent disease.

Periodontal AbscessConditions in which periodontal abscess is not related to inflammatory periodontal disease include tooth perforation or fracture and foreign body impaction. Poorly controlled diabetes mellitus has been considered a predisposing factor for periodontal abscess formation

Gingival AbscessThe gingival abscess is a localized, acute inflammatory lesion that may arise from a variety of sources, including microbial plaque infection, trauma, and foreign body impaction.Clinical features include a red, smooth, sometimes painful, often fluctuant swelling

Pericoronal AbscessThe pericoronal abscess results from inflammation of the soft tissue operculum, which covers a partially erupted tooth. This situation is most often observed around the mandibular third molars. As with the gingival abscess, the inflammatory lesion may be caused by the retention of microbial plaque, food impaction, or trauma.

Acute AbscessThe acute abscess is often an exacerbation of a chronic inflammatory periodontal lesion.Influencing factors include increased number and virulence of bacteria present, combined with lowered tissue resistance and lack of spontaneous drainage.The drainage may have been prevented by a deep, tortuous pocket morphology, debris, or closely adapted pocket epithelium blocking the pocket orifice. Acute abscesses are characterized by painful, red, edematous, smooth, and ovoid swelling of the gingival tissues.Exudate may be expressed with gentle pressure; the tooth may be percussion sensitive and feel elevated in the socket . Fever and regional lymphadenopathy are occasional findings

Chronic AbscessThe chronic abscess forms after the spreading infection has been controlled by spontaneous drainage, host response, or therapy. Once homeostasis between the host and infection has been reached, the patient may have few or no symptoms.However, dull pain may be associated with the clinical findings of a periodontal pocket, inflammation, and a fistulous tract

Signs and symptoms of abscess

SPECIFIC TREATMENT APPROACHESTreatment of the periodontal abscess includes two phases: Resolving the acute lesion, followed by the management of the resulting chronic conditionTreatment options

Drainage through Periodontal Pocket. The peripheral area around the abscess is anesthetized with sufficient topical and local anesthetic to ensure comfort.The pocket wall is gently retracted with a periodontal probe or curette in an attempt to initiate drainage through the pocket entrance

Gentle digital pressure and irrigation may be used to express exudates and clear the pocket.If the lesion is small and access uncomplicated, debridement in the form of scaling and root planing may be undertaken.If the lesion is large and drainage cannot be established, root debridement by scaling and root planing or surgical access should be delayed until the major clinical signs have decreasedIn these patients, use of adjunctive systemic antibiotics with short-term high-dose regimens is recommended. Antibiotic therapy alone without subsequent drainage and subgingival scaling is contraindicated

A, Chronic periodontal abscess of maxillary right canine. B, Using local anesthesia, periodontal probe is inserted to determine severity of thelesion. C, Using mesial and distal vertical incisions, a full-thickness flap is elevated, exposing severe bone dehiscence, a subgingival restoration, and rootcalculus. D, Root surface has been planed free of calculus and the restoration smoothed. E, Full-thickness flap has been replaced to its original position andsutured with absorbable sutures. F, At 3 months, gingival tissues are pink, firm, and well adapted to the tooth, with minimal periodontal probing depth.Gingival AbscessTreatment of the gingival abscess is aimed at reversal of the acute phase and when applicable, immediate removal of the cause. To ensure procedural comfort, topical or local anesthesia by infiltration is administered. When possible, scaling and root planing are completed to establish drainage and remove microbial deposits.Pericoronal AbscessAs with the other abscesses of the periodontium, the treatment of the pericoronal abscess is aimed at management of the acute phase, followed by resolution of the chronic condition. The acute pericoronal abscess is properly anesthetized for comfort, and drainage is established by gently lifting the soft tissue operculum with a periodontal probe or curetteIf the underlying debris is easily accessible, it may be removed, followed by gentle irrigation with sterile saline.If there is regional swelling, lymphadenopathy, or systemic signs, systemic antibiotics may be prescribed.

The patient is dismissed with instructions to rinse with warm salt water every 2 hours, and the area is reassessed after 24 hours.If discomfort was one of the original complaints, appropriate analgesics should be employed. Once the acute phase has been controlled, the partially erupted tooth may be definitively treated with either surgical excision of the overlying tissue or removal of the offending tooth.THANK YOUQUIZ