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Periodontal Abscess: Clinical Features and Management

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Localized collection of pus within the gum is called a periodontal abscess, and it is frequently the result of bacterial infection.

Medically reviewed by

Dr. Partha Sarathi Adhya

Published At January 19, 2024
Reviewed AtJanuary 19, 2024

Introduction:

A periodontal abscess is a dental condition in which pus builds up in a pocket near the gums. This often causes excruciating pain and swelling of the affected area. Even while it is less severe than certain other dental problems, it is nonetheless a major emergency. Usually, those who have already experienced gum disorders experience this. If left untreated, it can harm the gums and teeth and may lead to severe complications. There are two primary causes of periodontal abscess. Either it is associated with gum disease or caused by trauma. The trauma is caused by injury or entrapment of other things like dental floss, or food particles. The dentist must remove the pus, clean the affected area, and occasionally administer antibiotics to treat a periodontal abscess.

What Are the Etiologies of Periodontal Abscess?

Periodontal abscesses are infections in the tissues that support the teeth. More specifically it is an infection seen in the gum pockets or regions near the tooth roots. These abscesses may form independently in regions lacking gum pockets or as a result of pre-existing gum disease. A periodontal abscess may become more likely as a result of specific local factors. These elements consist of:

  1. Tooth Anomalies: Unusual tooth forms, including invaginated teeth (teeth with an unnatural folding within) or grooves on tooth roots, can produce areas where bacteria can gather and result in an abscess.

  2. Damage to the Tooth: A broken tooth can allow bacteria to enter the interior of the tooth, causing an infection and the development of an abscess.

  3. External Root Resorption: This condition is characterized by loss of tooth root structure from a variety of sources. It may offer a route for bacteria to enter the tissues nearby and result in an abscess.

In addition, the research studies note that recommending antibiotics alone, without additionally doing mechanical cleaning (such as scaling and root planing), can raise the risk of periodontal abscesses. This is due to the possibility of bacterial overgrowth and superinfection, including the emergence of abscesses, as a result of antibiotics' ability to change the population of the bacteria in gum pockets.

Periodontal disease and periodontal abscesses share a similar microbiology. Gram-negative anaerobic bacteria (GNABS) are the most prevalent bacterial species in periodontal abscesses. Porphyromonas gingivalis, which is present in 50 to 100 percent of cases, is one of the common bacteria in these abscesses. Campylobacter species, Capnocytophaga species, Aggregatibacter actinomycetemcomitans, Prevotella melaninogenica, Fusobacterium nucleatum, Tannerella forsythia, Treponema species, Prevotella intermedia, and gram-negative enteric rods are other bacteria linked to periodontal abscesses.

What Is the Pathophysiology of Periodontal Abscess?

A lot of periodontal abscesses begin when something becomes impaled in a small space near the teeth. This may occur due to a variety of factors, including the buildup of hard deposits around the teeth or due to the insertion of foreign objects like dental floss or pieces of toothpicks.

Bacteria begin to accumulate when this compartment becomes clogged because it is unable to properly clean such areas. However, the release of damaging enzymes by the body's defense cells, known as neutrophils, causes the majority of the damage in these abscesses.

To put it another way, periodontal abscesses typically occur when something becomes jammed in a tight spot around the teeth. Bacteria grow because it is difficult to clean around this obstruction. However, the body's defense cells, which release harmful compounds, are what cause damage.

What Are the Clinical Features of Periodontal Abscess?

It is crucial to discuss any past gum procedures or recent antibiotic usage with the dentist. These specifics aid dentists in comprehending the potential reasons for gum issues, which can range from infections brought on by foreign things lodged in the gums to residual plaque. It is essential knowledge for diabetic individuals because they are more prone to gum infections. Due to their higher risk, dentists provide diabetes patients with particular attention.

Symptoms include:

  1. Swelling: Which occurs due to inflammation of gums.

  2. Pain: Gum abscesses can hurt, and the patient may complain of pain while chewing.

  3. Loosening of Teeth: Loss of gum tissue may cause teeth to feel loose.

  4. Pus and Terrible Taste: Pus is possible and frequently observed when applied pressure. It can also leave a horrible taste in the mouth.

During examinations certain symptoms to look for, including

  1. Deep Pockets: Gaps deeper than 6 mm between teeth and gums.

  2. Tooth Mobility: Loose teeth as a result of gum problems.

  3. Suppuration and Pus: Pus is visible with pressure or probing.

  4. Gum Sensitivity: Gums may be sensitive to touch.

  5. X-rays: To detect bone loss surrounding teeth, which is essential for diagnosis, dentists utilize X-rays.

Gum abscesses can be of various types. These are:

  1. Location: It can be periodontal (deeper in gum structures) or gingival (in the gums).

  2. Duration: Based on the duration, it can be chronic (long-lasting, frequently accompanied by a sinus tract) or acute (sudden and unpleasant).

  3. Number: It can be single (restricted to a specific area) or several (associated with systemic conditions like diabetes).

What Are the Treatment Options?

A gum abscess is typically treated in two steps:

  1. Acute Management: The dentist starts by attempting to lessen discomfort and prevent the infection from spreading. If the infection has spread to other areas of the body, they may carefully drain the abscess, clean the affected area, and administer medications.

  2. Final Treatment: Following the acute stage, the dentist designs a long-term course of action. This could need a thorough cleaning of the gums, the extraction of infected teeth, or in some circumstances, periodontal surgery.

The treatment procedure includes the following steps:

  1. Draining the Abscess: The diseased region may be carefully cleaned by the dentist, who will also take out any foreign items lodged in the gums.

  2. Rinsing and Scaling: Removing bacteria and dead tissue from the gum pockets by utilizing antiseptic rinses is necessary. Scaling is done to remove hard deposits in the teeth.

  3. Removal of a Tooth: If a tooth is seriously damaged or severely mobile it needs to be extracted.

  4. Antibiotics: If the infection is serious or has spread to other body regions, antibiotics are given. The condition and allergies of the patient influence the antibiotic selection. Also, antibiotics help reduce teeth infections.

  5. Surgery: In some circumstances, surgery may be required to remove calculus and deep infections or to clean the periapical region.

  6. Follow-up: After receiving initial care, patients need to follow dentist recommendations, which may include rinsing with salt water and consuming enough fluids to ease swelling.

  7. Multiple Abscesses: Numerous abscesses in a patient may be a sign of a more serious medical condition, such as diabetes. Therefore, more tests might be required.

  8. Periodontal Surgery: In persistent cases, surgery may be required. This involves actions to drain the abscess and remove any remaining calculus.

Conclusion:

Periodontal abscess is a localized gum infection that, if left untreated, can become more serious. It is important to be aware of the symptoms, such as gum swelling, pain, or pus formation. This helps to avail dental care as soon as possible. Dentists can clean the afflicted area, drain the abscess, and, if necessary, prescribe medications. Early treatment not only reduces discomfort but also stops the spread of infection to other mouth and body regions. For maintaining good oral health and general well-being, prompt action and routine dental treatment are essential.

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Dr. Ashwini Kumar

Dentistry

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periodontal gum diseaseperiodontal pockets
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