Abscesses of the periodontium

PERIODONTAL ABSCESS

1. Abscesses of the Periodontium

2. Definition:
ABSCESS:
Localizedcollectionofpurulentexudate(pus)inacavityformedby
thedisintegrationoftissuesduetoaninfectiousprocessorforeignmaterial.
-Glossary of Periodontal Terms

3. Classification:
•(A) Depending on the location of the abscess,
•Gingival abscesses
•Periodontal/Lateral/Parietal abscesses
•Pericoronal abscess.
•(B) Depending on the course of the lesion,
•Acute
•Chronic
•(C) Depending on the number,
•Single and
•Multiple periodontal abscesses.

4. •F. nucleatum,
•P. intermedia,
•P. gingivalis,
•P. micros, and
•T.forsythia.
Microorganisms associated :

5. Gingival Abscess :
•Thegingivalabscessisalocalized,acuteinflammatory
lesionthatmayarisefromavarietyofsources,
includingmicrobialplaqueinfection,trauma,and
foreignbodyimpaction.
•Clinicalfeaturesincludeared,smooth,sometimes
painful,oftenfluctuantswelling

6. Periodontal abscess :
•A periodontal abscess is a localized accumulation of
pus within the gingival wall of a periodontal pocket.
•Lateral abscess / Parietal abscess
•Periodontal abscess is different from periapical
abscess as the later has pulpal origin of infection.

7. Clinical Features :
An ovoid elevation of the gingiva along the lateral
aspect of the root
The gingiva is edematous and red, with a smooth,
shiny surface.
The shape and consistency -area may be domelike
and relatively firm or pointed and soft.
Pus may be expressed from the gingival margin with
gentle digital pressure..

8. Symptoms
•Pain,
•Swelling,
•Suppuration,
•Bleeding on probing, and
•Mobility of the involved tooth.
Signs
•Cervical lymphadenopathy and
•An elevated white blood cell count.

9. Etiology :
Extensionofinfectionfromaperiodontalpocketdeeplyintothesupporting
periodontaltissues.
Lateralextensionofinflammationfromtheinnersurfaceofaperiodontalpocket.
Deepandtortuousperiodontalpockets,aperiodontalabscessmayforminthecul-
de-sac.
Incompleteremovalofcalculusduringtreatmentofaperiodontalpocket.
Traumatothetoothorperforationofthelateralwalloftherootinendodontic
therapy.

10. Diagnosis should be based on
Patients chief complaint
Clinical signs and symptoms
Additional information can be obtained through a careful medical and dental
history, and radiographic examination.
Suspectedareashouldbeprobedcarefullyalongthegingivalmarginin
relationtoeachtoothsurfacetodetectachannelfromthemarginalareatothe
deeperperiodontaltissues.Continuityofthelesionwiththegingivalmarginis
clinicalevidencethattheabscessisperiodontal.
Diagnosis :

11. Gingival abscess
Periapical abscess,
Lateral periodontal cyst,
Pericoronitis
Vertical root fracture,
Osteomyelitis
Eosinophilic granuloma
Differential Diagnosis :

12. Periocoronal Abscess :
•Thepericoronalabscessresultsfrominflammationofthe
softtissueoperculum,whichcoversapartiallyeruptedtooth.
•Thissituationismostoftenobservedaroundthemandibular
thirdmolars.
•Aswiththegingivalabscess,theinflammatorylesionmay
becausedbytheretentionofmicrobialplaque,food
impaction,ortrauma.

13. Treatment of Gingival Abscess, the protocol should include the following.
Elimination of the foreign object, through careful debridement.
Drainage through the sulcus with a probe or light scaling,
Rinsing with warm saline and follow-up after 24-48 hours
Treatment of Gingival Abscess :

14. TreatmentofAcuteperiodontalabscessusuallyinvolvestwostages
Managementoftheacutelesion.
Theappropriatetreatmentoftheoriginaland/orresiduallesion,oncethe
acutesituationshasbeencontrolled.
Treatment of Periodontal Abscess:

15. Thepurposeoftreatmentofacuteperiodontalabscessisto
Alleviatepain,
Control the spread of infection, and
To establish drainage.
Treatment Protocol
Incision and drainage (closed or open approach)
Scaling and Root planning
Compression and debridement of soft tissue wall.
Use of different systemically administered antibiotics
Tooth extraction.

16. Treatment of Chronic periodontal abscess
Surgical therapy
Gingivectomy
Flap procedure
(Mainly in abscess associated with deep vertical defects, where the
resolution of the abscess may only be achieved by a surgical
operation)
Objective : To eliminate the remaining calculus and to obtain drainage at the
same time.

17. Treatment of Pericoronal Abscess, the protocol should include the following.
Debride/irrigate under pericoronal flap
Tissue recontouring (removing tissue flap)
Extraction of involved and/or opposing tooth
Antimicrobials (local and/or systemic as needed) Culture and
sensitivity
Follow-up
Treatment of Pericoronal Abscess:

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