This document summarizes information on periodontal abscesses. It begins by defining periodontal abscesses as localized acute bacterial infections confined to the tissues of the periodontium. It then discusses the classification, microbiology, pathogenesis, predisposing factors, diagnosis, and differential diagnosis of periodontal abscesses. Regarding treatment, it states that periodontal abscesses were historically a main reason for tooth extraction, but today the main therapeutic approaches discussed are drainage and debridement, systemic antibiotics, and periodontal surgical procedures in the chronic phase.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontal abscesses are localized purulent infections within the tissues adjacent to the periodontal pocket that can lead to destruction of the periodontal ligament and alveolar bone. They are classified based on location, course, number, affected tissues, and cause. The most common types are periodontal abscesses, gingival abscesses, and pericoronal abscesses. Treatment involves incision and drainage of the abscess, scaling and root planing, use of antibiotics, and sometimes surgery or tooth extraction. Complications can include tooth loss or dissemination of the infection.
1. Oral bacterial biofilms can enter the bloodstream through disruption caused by oral procedures like dental cleanings, tooth extractions, or chewing. This leads to transient bacteremia.
2. Viridans group streptococci and Actinomyces odontolyticus are among the oral bacteria most commonly found in the bloodstream, and they have attributes like adhesion that allow them to cause infections in other parts of the body.
3. Procedures that cause more tissue trauma like tooth extractions, periodontal probing, and endodontic treatments have a higher risk of resulting in bacteremia compared to less invasive activities like brushing or flossing. The presence of gum
This document summarizes various causes of non-plaque induced gingivitis, including specific bacterial, viral, and fungal infections that can cause gingival inflammation and lesions. It describes conditions such as herpetic gingivostomatitis caused by the herpes simplex virus and candidosis caused by Candida albicans. It also discusses genetic causes like hereditary gingival fibromatosis and systemic diseases that can involve the gingiva, such as lichen planus, pemphigoid, and pemphigus vulgaris. Allergic reactions to dental materials and oral hygiene products are another potential cause of non-plaque gingivitis covered.
BASIC CONCEPTS OF INFLAMMATION-STAGES OF INFLAMMATION-ALL ABOUT GINGIVAL INFLAMMATION-CLINICAL FEATURES AND STAGES OF GINGIVITIS-HOW TO MANAGE-ALL IN ONE-FOR B.D.S LEVEL PROJECTS AND SEMINARS
1) The document discusses various acute gingival infections including traumatic lesions, viral infections like herpetic gingivostomatitis, bacterial infections like necrotizing ulcerative gingivitis, fungal diseases, gingival abscesses, and drug allergies.
2) It provides detailed information about necrotizing ulcerative gingivitis (NUG), including causes, signs and symptoms, treatment for non-ambulatory and ambulatory patients, and complications if left untreated.
3) Information is also given about acute herpetic gingivostomatitis caused by HSV viruses, recurrent aphthous stomatitis (canker sores),
This document outlines the pathogenesis of periodontal disease. It begins by defining pathogenesis as the origination and development of disease. It then defines periodontal disease as an infection of the gums, periodontal ligament and alveolar bone. Healthy gums are described as pink, firm and not inflamed or swollen, while gum diseases like gingivitis and periodontitis are defined. The document goes on to describe the inflammatory response in the periodontium, including microbial virulence factors from bacteria and host-derived inflammatory mediators like cytokines and prostaglandins. Clinical signs of periodontal disease are provided.
This was initially made by me for my class assignment, helps me with my revision. I hope this helps you guys as well. Also, the references were taken from carranza 12th edition and jaypee.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontal abscesses are localized purulent infections within the tissues adjacent to the periodontal pocket that can lead to destruction of the periodontal ligament and alveolar bone. They are classified based on location, course, number, affected tissues, and cause. The most common types are periodontal abscesses, gingival abscesses, and pericoronal abscesses. Treatment involves incision and drainage of the abscess, scaling and root planing, use of antibiotics, and sometimes surgery or tooth extraction. Complications can include tooth loss or dissemination of the infection.
1. Oral bacterial biofilms can enter the bloodstream through disruption caused by oral procedures like dental cleanings, tooth extractions, or chewing. This leads to transient bacteremia.
2. Viridans group streptococci and Actinomyces odontolyticus are among the oral bacteria most commonly found in the bloodstream, and they have attributes like adhesion that allow them to cause infections in other parts of the body.
3. Procedures that cause more tissue trauma like tooth extractions, periodontal probing, and endodontic treatments have a higher risk of resulting in bacteremia compared to less invasive activities like brushing or flossing. The presence of gum
This document summarizes various causes of non-plaque induced gingivitis, including specific bacterial, viral, and fungal infections that can cause gingival inflammation and lesions. It describes conditions such as herpetic gingivostomatitis caused by the herpes simplex virus and candidosis caused by Candida albicans. It also discusses genetic causes like hereditary gingival fibromatosis and systemic diseases that can involve the gingiva, such as lichen planus, pemphigoid, and pemphigus vulgaris. Allergic reactions to dental materials and oral hygiene products are another potential cause of non-plaque gingivitis covered.
BASIC CONCEPTS OF INFLAMMATION-STAGES OF INFLAMMATION-ALL ABOUT GINGIVAL INFLAMMATION-CLINICAL FEATURES AND STAGES OF GINGIVITIS-HOW TO MANAGE-ALL IN ONE-FOR B.D.S LEVEL PROJECTS AND SEMINARS
1) The document discusses various acute gingival infections including traumatic lesions, viral infections like herpetic gingivostomatitis, bacterial infections like necrotizing ulcerative gingivitis, fungal diseases, gingival abscesses, and drug allergies.
2) It provides detailed information about necrotizing ulcerative gingivitis (NUG), including causes, signs and symptoms, treatment for non-ambulatory and ambulatory patients, and complications if left untreated.
3) Information is also given about acute herpetic gingivostomatitis caused by HSV viruses, recurrent aphthous stomatitis (canker sores),
This document outlines the pathogenesis of periodontal disease. It begins by defining pathogenesis as the origination and development of disease. It then defines periodontal disease as an infection of the gums, periodontal ligament and alveolar bone. Healthy gums are described as pink, firm and not inflamed or swollen, while gum diseases like gingivitis and periodontitis are defined. The document goes on to describe the inflammatory response in the periodontium, including microbial virulence factors from bacteria and host-derived inflammatory mediators like cytokines and prostaglandins. Clinical signs of periodontal disease are provided.
This was initially made by me for my class assignment, helps me with my revision. I hope this helps you guys as well. Also, the references were taken from carranza 12th edition and jaypee.
Gingivitis is the most common form of gingival disease and is caused by bacterial infection resulting in inflammation of the gingival tissue. The characteristics of gingivitis include redness, swelling, bleeding upon provocation, and a change in consistency but no loss of attachment or bone loss. Gingivitis can be classified as dental plaque-induced or non-plaque induced. Dental plaque-induced gingivitis can be modified by local factors, systemic factors, medications, or malnutrition. Non-plaque induced gingivitis can result from bacterial, viral, fungal infections or genetic conditions.
This document provides an overview of the pathogenesis of periodontal disease. It begins with definitions of pathogenesis and periodontitis. Key points include: plaque bacteria initiate inflammatory responses leading to tissue damage; the host immune response determines susceptibility; and the transition from gingivitis to periodontitis involves a shift from localized to widespread inflammation and bone/tissue loss. Histopathological changes are described at each disease stage. The roles of bacterial virulence factors and host inflammatory mediators such as cytokines are discussed.
Lecture xiii ju-oral pathology-lecture xiii-perio5lalola
This document discusses non-plaque induced gingival lesions. It covers 7 categories: 1) diseases of specific bacterial origin like streptococcal infections and syphilis. 2) Viral diseases like herpes and HPV. 3) Fungal infections like candidiasis. 4) Genetic conditions like gingival fibromatosis. 5) Systemic conditions that manifest in the gingiva, such as lichen planus, pemphigoid, and pemphigus vulgaris. 6) Traumatic lesions caused by chemicals, physical factors, or thermal injury. 7) Other conditions including vascular and epithelial neoplasms and granulomatous diseases. Numerous visual examples are provided to illustrate the
Periodontal abscess is a localised purulent infection in the tissues adjacent to the periodontal pocket that may lead to the destruction of the periodontal ligament and alveolar bone. Periodontal abscess is the third most prevalent emergency infection after acute alveolar abscess and pericoronitis. It could lead to complications due to bacteremia that may cause infection at distant locations. Proper management of the abscess is crucial to alleviate pain, establish drainage and control the spread of infection.
1. The document discusses various oral conditions including necrotizing ulcerative gingivitis (NUG), acute herpetic gingivostomatitis (AHG), recurrent aphthous stomatitis (RAS), gingival abscess, and pericoronitis. It provides details on the classification, signs and symptoms, etiology, diagnosis and treatment of each condition.
2. NUG is caused by fusospirochetal organisms and presents as crater-like ulcers that can destroy the periodontium if left untreated. Treatment involves antibiotics and removing necrotic tissue.
3. AHG is a viral infection caused by HSV that presents as clusters of
Acute necrotising ulcerative gingivitis is a rare condition characterized by necrosis of the gingiva and interdental papillae. It frequently occurs during times of stress and poor oral hygiene. The condition is caused by fusiform bacillus and Borrelia vincentii bacteria. Clinically, the gingiva becomes painful and develops punched-out ulcers. It can spread to other oral tissues and rarely the skin, causing further complications.
Everything a dentist needs to know about a periodontal abscess is here.
Along with all the relevant facts, references, definitions, classifications, and each and every statement is given with proper detail
This document summarizes various acute periodontal conditions, including abscesses of the periodontium (gingival, periodontal, pericoronal), necrotizing periodontal diseases (necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis), gingival diseases of viral origin (primary herpetic gingivostomatitis, recurrent oral herpes), recurrent aphthous stomatitis, and allergic reactions in the oral cavity. Treatment options focus on drainage, debridement, antimicrobials, pain control, and identifying/eliminating predisposing factors or allergens. Comprehensive evaluation and follow-up are important after resolution of acute
Pediatric soft tissue lesions/certified fixed orthodontic courses by Indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Necrotizing ulcerative gingivitis (NUG), also known as trench mouth, is an infectious disease of the gums causing bleeding, ulcers, and pain. It was first described in ancient Greece and differentiated from other conditions in the 18th century. It is caused by an infection of fusiform-spirochete bacteria like P. intermedia and Fusobacterium. Risk factors include nutritional deficiencies, drug or alcohol abuse, stress, and immunodeficiency. Clinically, it presents as crater-like ulcers on the gums with gray pseudomembranes and bleeding. Diagnosis is based on clinical signs and symptoms as well as bacterial smears and biopsy findings.
Gingivitis is defined as the inflammation of gingival tissue.Gingival inflammation has two components: the acute
inflammatory component, with vasodilation, edema, and
polymorphonuclear infiltration, and the chronic inflammatory
component, with B and T lymphocytes and capillary
proliferation forming a granulomatous response.
Gingivitis affects an estimated 80% of the population, most periodontal disease arises from or is aggravated by accumulation of plaque, and periodontitis is associated
particularly with anaerobes such as Bacteroides. Calculus (tartar) may form calcification of plaque above or below the gum line, and the plaque that collects on calculus exacerbates the inflammation. The inflammatory reaction is associated with progressive loss of periodontal ligament and alveolar bone.T.tenax is a widespread flagellated protozoan that inhabits the human oral cavity in and around diseased teeth and gums The role of Trichomonas tenax as a pathogen had been clearly implicated in various pathological processes that arise outside the boundaries of the mouth. Although a relationship between the increased occurrence of this protozoan and progression of periodontal disease has been demonstrated so the present study aimed to estimate the occurrence of T.tenax in individuals having oral infections calculi samples were collected from 58 patients who were diagnosed as having periodontitis and/or gingivitis , then were subjected to direct smear examination. The results showed that the positivity rate of T. tenax is 13%.
Conclusions: This result support the association between T. tenax infection and bad oral hygeine and suggest the usefulness of elimination of this protozoa to achieve radical cure of gingivitis and periodontitis
This document discusses different types of gingival enlargement, including classifications based on etiology and location. Inflammatory enlargements can be acute or chronic, with chronic enlargement resulting from plaque accumulation. Systemic diseases like leukemia and granulomatous diseases can also cause enlargement. Neoplastic enlargements include benign tumors like fibromas and papillomas, as well as malignant tumors like squamous cell carcinoma. Drug-induced enlargement is a common side effect of medications like anticonvulsants, immunosuppressants, and calcium channel blockers. The document also covers indices used to grade the severity of enlargement.
Periodontal abscesses are acute bacterial infections localized to the periodontium. They commonly occur in 6-14% of dental emergencies. Diagnosis involves examination of the gingiva for swelling, redness and tenderness. Treatment involves drainage of pus, antibiotic therapy, and debridement to eliminate the bacterial cause. Definitive treatment focuses on restoring function and maintaining periodontal health. Early diagnosis and intervention are important for successful management of periodontal abscesses.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document discusses several conditions that can affect the gingiva including necrotizing ulcerative gingivitis (NUG), primary herpetic gingivostomatitis, and recurrent aphthous stomatitis. NUG is a painful inflammatory disease affecting the gingiva caused by spirochetes and fusiform bacteria. It is characterized by ulcers and can cause bad breath and increased salivation. Treatment involves antibiotics, rinsing with hydrogen peroxide, and improving oral hygiene. Primary herpetic gingivostomatitis is caused by the herpes simplex virus and produces gingival lesions and sores. It typically resolves within 7-10 days with top
The document outlines various types of gingival diseases in children, including eruption gingivitis, dental plaque induced gingivitis, allergies, and acute gingival diseases. Acute gingival diseases discussed include herpes simplex virus infection, which causes painful sores in the mouth and gums and is treated with antiviral medication and pain relief. Recurrent aphthous ulcers and acute necrotizing gingivitis are also covered as acute conditions, as well as acute candidiasis and bacterial infections. Chronic nonspecific gingivitis and gingival diseases modified by systemic factors are also classified.
Interrelationship between periodontics and endodonticsUniversity
This document discusses the interrelationship between periodontics and endodontics. It describes how pathological conditions in the dental pulp can influence the periodontium, such as how pulp necrosis is associated with inflammatory involvement of the periodontal tissue. It also discusses how endodontic treatment measures and conditions like root perforations and vertical root fractures can impact the periodontium. Finally, it explores how periodontal disease can in turn influence the condition of the dental pulp.
Gingivitis is the most common form of gingival disease and is caused by bacterial infection resulting in inflammation of the gingival tissue. The characteristics of gingivitis include redness, swelling, bleeding upon provocation, and a change in consistency but no loss of attachment or bone loss. Gingivitis can be classified as dental plaque-induced or non-plaque induced. Dental plaque-induced gingivitis can be modified by local factors, systemic factors, medications, or malnutrition. Non-plaque induced gingivitis can result from bacterial, viral, fungal infections or genetic conditions.
This document provides an overview of the pathogenesis of periodontal disease. It begins with definitions of pathogenesis and periodontitis. Key points include: plaque bacteria initiate inflammatory responses leading to tissue damage; the host immune response determines susceptibility; and the transition from gingivitis to periodontitis involves a shift from localized to widespread inflammation and bone/tissue loss. Histopathological changes are described at each disease stage. The roles of bacterial virulence factors and host inflammatory mediators such as cytokines are discussed.
Lecture xiii ju-oral pathology-lecture xiii-perio5lalola
This document discusses non-plaque induced gingival lesions. It covers 7 categories: 1) diseases of specific bacterial origin like streptococcal infections and syphilis. 2) Viral diseases like herpes and HPV. 3) Fungal infections like candidiasis. 4) Genetic conditions like gingival fibromatosis. 5) Systemic conditions that manifest in the gingiva, such as lichen planus, pemphigoid, and pemphigus vulgaris. 6) Traumatic lesions caused by chemicals, physical factors, or thermal injury. 7) Other conditions including vascular and epithelial neoplasms and granulomatous diseases. Numerous visual examples are provided to illustrate the
Periodontal abscess is a localised purulent infection in the tissues adjacent to the periodontal pocket that may lead to the destruction of the periodontal ligament and alveolar bone. Periodontal abscess is the third most prevalent emergency infection after acute alveolar abscess and pericoronitis. It could lead to complications due to bacteremia that may cause infection at distant locations. Proper management of the abscess is crucial to alleviate pain, establish drainage and control the spread of infection.
1. The document discusses various oral conditions including necrotizing ulcerative gingivitis (NUG), acute herpetic gingivostomatitis (AHG), recurrent aphthous stomatitis (RAS), gingival abscess, and pericoronitis. It provides details on the classification, signs and symptoms, etiology, diagnosis and treatment of each condition.
2. NUG is caused by fusospirochetal organisms and presents as crater-like ulcers that can destroy the periodontium if left untreated. Treatment involves antibiotics and removing necrotic tissue.
3. AHG is a viral infection caused by HSV that presents as clusters of
Acute necrotising ulcerative gingivitis is a rare condition characterized by necrosis of the gingiva and interdental papillae. It frequently occurs during times of stress and poor oral hygiene. The condition is caused by fusiform bacillus and Borrelia vincentii bacteria. Clinically, the gingiva becomes painful and develops punched-out ulcers. It can spread to other oral tissues and rarely the skin, causing further complications.
Everything a dentist needs to know about a periodontal abscess is here.
Along with all the relevant facts, references, definitions, classifications, and each and every statement is given with proper detail
This document summarizes various acute periodontal conditions, including abscesses of the periodontium (gingival, periodontal, pericoronal), necrotizing periodontal diseases (necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis), gingival diseases of viral origin (primary herpetic gingivostomatitis, recurrent oral herpes), recurrent aphthous stomatitis, and allergic reactions in the oral cavity. Treatment options focus on drainage, debridement, antimicrobials, pain control, and identifying/eliminating predisposing factors or allergens. Comprehensive evaluation and follow-up are important after resolution of acute
Pediatric soft tissue lesions/certified fixed orthodontic courses by Indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Necrotizing ulcerative gingivitis (NUG), also known as trench mouth, is an infectious disease of the gums causing bleeding, ulcers, and pain. It was first described in ancient Greece and differentiated from other conditions in the 18th century. It is caused by an infection of fusiform-spirochete bacteria like P. intermedia and Fusobacterium. Risk factors include nutritional deficiencies, drug or alcohol abuse, stress, and immunodeficiency. Clinically, it presents as crater-like ulcers on the gums with gray pseudomembranes and bleeding. Diagnosis is based on clinical signs and symptoms as well as bacterial smears and biopsy findings.
Gingivitis is defined as the inflammation of gingival tissue.Gingival inflammation has two components: the acute
inflammatory component, with vasodilation, edema, and
polymorphonuclear infiltration, and the chronic inflammatory
component, with B and T lymphocytes and capillary
proliferation forming a granulomatous response.
Gingivitis affects an estimated 80% of the population, most periodontal disease arises from or is aggravated by accumulation of plaque, and periodontitis is associated
particularly with anaerobes such as Bacteroides. Calculus (tartar) may form calcification of plaque above or below the gum line, and the plaque that collects on calculus exacerbates the inflammation. The inflammatory reaction is associated with progressive loss of periodontal ligament and alveolar bone.T.tenax is a widespread flagellated protozoan that inhabits the human oral cavity in and around diseased teeth and gums The role of Trichomonas tenax as a pathogen had been clearly implicated in various pathological processes that arise outside the boundaries of the mouth. Although a relationship between the increased occurrence of this protozoan and progression of periodontal disease has been demonstrated so the present study aimed to estimate the occurrence of T.tenax in individuals having oral infections calculi samples were collected from 58 patients who were diagnosed as having periodontitis and/or gingivitis , then were subjected to direct smear examination. The results showed that the positivity rate of T. tenax is 13%.
Conclusions: This result support the association between T. tenax infection and bad oral hygeine and suggest the usefulness of elimination of this protozoa to achieve radical cure of gingivitis and periodontitis
This document discusses different types of gingival enlargement, including classifications based on etiology and location. Inflammatory enlargements can be acute or chronic, with chronic enlargement resulting from plaque accumulation. Systemic diseases like leukemia and granulomatous diseases can also cause enlargement. Neoplastic enlargements include benign tumors like fibromas and papillomas, as well as malignant tumors like squamous cell carcinoma. Drug-induced enlargement is a common side effect of medications like anticonvulsants, immunosuppressants, and calcium channel blockers. The document also covers indices used to grade the severity of enlargement.
Periodontal abscesses are acute bacterial infections localized to the periodontium. They commonly occur in 6-14% of dental emergencies. Diagnosis involves examination of the gingiva for swelling, redness and tenderness. Treatment involves drainage of pus, antibiotic therapy, and debridement to eliminate the bacterial cause. Definitive treatment focuses on restoring function and maintaining periodontal health. Early diagnosis and intervention are important for successful management of periodontal abscesses.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This document discusses several conditions that can affect the gingiva including necrotizing ulcerative gingivitis (NUG), primary herpetic gingivostomatitis, and recurrent aphthous stomatitis. NUG is a painful inflammatory disease affecting the gingiva caused by spirochetes and fusiform bacteria. It is characterized by ulcers and can cause bad breath and increased salivation. Treatment involves antibiotics, rinsing with hydrogen peroxide, and improving oral hygiene. Primary herpetic gingivostomatitis is caused by the herpes simplex virus and produces gingival lesions and sores. It typically resolves within 7-10 days with top
The document outlines various types of gingival diseases in children, including eruption gingivitis, dental plaque induced gingivitis, allergies, and acute gingival diseases. Acute gingival diseases discussed include herpes simplex virus infection, which causes painful sores in the mouth and gums and is treated with antiviral medication and pain relief. Recurrent aphthous ulcers and acute necrotizing gingivitis are also covered as acute conditions, as well as acute candidiasis and bacterial infections. Chronic nonspecific gingivitis and gingival diseases modified by systemic factors are also classified.
Interrelationship between periodontics and endodonticsUniversity
This document discusses the interrelationship between periodontics and endodontics. It describes how pathological conditions in the dental pulp can influence the periodontium, such as how pulp necrosis is associated with inflammatory involvement of the periodontal tissue. It also discusses how endodontic treatment measures and conditions like root perforations and vertical root fractures can impact the periodontium. Finally, it explores how periodontal disease can in turn influence the condition of the dental pulp.
This document discusses the relationship between periodontal and endodontic diseases. It begins by establishing that the tooth, pulp, and supporting structures should be viewed as one biologic unit. There are various pathways by which communication can occur between the pulp and periodontium, including developmental pathways like lateral canals, pathological pathways caused by trauma or resorption, and iatrogenic pathways from dental procedures. Pulpal and periodontal problems are responsible for over 50% of tooth mortality. The document goes on to classify periodontal-endodontic lesions based on whether the primary source of disease is endodontic or periodontal and whether secondary involvement occurred.
The document discusses acute periodontal infections including abscesses, pericoronitis, and herpetic gingivostomatitis. It describes the clinical features, causes, microbiology, diagnosis and treatment of each condition. Abscesses are classified as gingival, periodontal or pericoronal depending on their location. Pericoronitis is inflammation around an unerupted tooth, usually due to food debris trapped under the gums. Herpetic gingivostomatitis is caused by the herpes simplex virus and presents as diffuse gingival swelling and vesicles that rupture, leaving painful ulcers. Prompt diagnosis and treatment including drainage, debridement and antibiotics are important to resolve the infections
presentation abscess of the periodontium .pptxmisthysrishty
A periodontal abscess is a localized collection of pus within the periodontal tissues caused by bacterial infection. It is usually associated with untreated periodontitis and moderate to deep periodontal pockets. Symptoms may include pain, swelling, tenderness, and tooth mobility. The abscess microbiota typically includes anaerobic bacteria like Porphyromonas gingivalis and Prevotella intermedia. Diagnosis is based on clinical signs and symptoms as well as radiographic evidence of bone loss. Treatment involves drainage, antibiotics, and resolving the underlying periodontal disease.
This document summarizes the pathogenesis of endo-perio lesions. It discusses how pathological changes in the periodontium or pulp can lead to infection of the other due to their intimate connection through pathways like lateral canals. Periodontal disease typically progresses from the gums to the apex over time. Pulpal disease can be either chronic or acute, resulting in increased pressure and release of toxins into pathways. The effects of periodontal disease on the pulp are unclear but may include degenerative changes if the apex is involved. Successful treatment requires accurate diagnosis of the pulpal and periodontal status.
This document reviews periodontic-endodontic lesions that originate from infections of the periodontium or dental pulp. Pulpal infections can spread to the periodontium through lateral and accessory canals, causing retrograde peri-odontitis. Conversely, periodontal disease can spread to the pulp through these same pathways. The diagnosis of whether a lesion originated from the periodontium or pulp can be difficult, as the clinical and radiographic features may be similar. Determining pulp vitality is important for differential diagnosis and treatment planning.
Periodontal disease and pulpal infection are caused by polymicrobial infections involving both aerobic and anaerobic bacteria. While some of the same bacteria can be found in both infected root canals and periodontal pockets, the root canal flora is typically less complex. Necrosis of the pulp can lead to bone resorption and lesions around the root or in the furcation. These lesions may remain small or expand and involve both pulpal and periodontal tissues, complicating diagnosis and treatment. Appropriate endodontic and periodontal therapies are both usually required to fully resolve the issues.
This document discusses periodontic-endodontic lesions, which can originate from infections of the periodontium or dental pulp. It describes the anatomical connections between the tissues and various classifications of lesions. Microorganisms like Fusobacterium and Prevotella are often involved in both periodontal and pulp lesions. Accessory canals and dentinal tubules allow communication between tissues. Diagnosis considers factors like tooth vitality, lesion localization, and radiographic findings. Treatment involves completing endodontic therapy followed by periodontal treatment to address the underlying etiologies.
This document provides information about Dr. Giuseppe Bruno Pitassi's qualifications and specializations. It then discusses acute infections of the oral and para-oral tissues, including their classification, etiology, pathogenesis, and microbiology. Key points include that 92-94% of these infections are odontogenic in origin, mainly caused by anaerobic bacteria. The three major origins of odontogenic infections are periapical periodontitis, marginal periodontitis, and pericoronitis. Pathways of infection are described originating from dental sources such as infected or necrotic pulps leading to periapical abscesses. Radiographic images show examples of periapical and periodontal abscesses.
Pericoronitis refers to inflammation around the crown of an unerupted tooth. It most commonly occurs with the mandibular third molar and can be acute, subacute, or chronic. Acute pericoronitis presents as a red, swollen, painful lesion that may cause fever and lymphadenitis. Treatment involves antibiotics and flushing the area for mild cases or flap removal for persistent symptoms to prevent recurrence. The decision to retain or extract the tooth depends on its stage of eruption, position, and likelihood of further eruption without complications.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The document discusses the relationship between pulpal and periodontal diseases. It states that diseases of the pulp or periodontium can lead to secondary diseases in the other via the apical foramen, lateral canals, or dentinal tubules. Both endodontic and periodontal examinations are important to diagnose the origin of lesions. Treatment should focus first on the primary disease, but both may need treatment if the secondary disease is established.
This document summarizes various oral pathologies including caries, periapical disease, periodontal disease, infections related to retained or impacted teeth, and bone/jaw conditions like osteomyelitis, osteoradionecrosis, and bisphosphonate-related osteonecrosis. It describes the etiology, clinical presentation, radiographic appearance, and management of these conditions. Key points include that caries is caused by bacteria in plaque interacting with carbohydrates over time, periapical infections can develop from deep caries or trauma and may lead to osteolytic or sclerotic changes, and periodontitis results from an inflammatory response to bacterial plaque if left untreated.
Periodontal abcess in dentistry concise view.pptxHazimrizk1
Periodontal abscess concise view discussing its Definition, Etiology and risk factors,
Pathogenesis,signs and symptomes,Clinical features
Diagnosisand diffrential diagnosis
Management
odontogenic inflammatory disease of the jaw. chronic periodontitis and apical...SagharMousavi1
Odontogenic inflammatory diseases refer to infections or inflammatory processes originating from the teeth and surrounding structures. Common examples include pulpitis, periapical abscess, and chronic periodontitis. These conditions pose a significant global burden and can impact quality of life through pain, impaired function, and tooth loss. Risk factors include poor oral hygiene, smoking, and systemic diseases. Treatment may involve nonsurgical approaches like scaling and root planing or surgical options such as apical surgery to address advanced or persistent cases.
This document provides an overview of endodontic microbiology. It discusses apical periodontitis as an infectious disease primarily caused by bacterial infection of the root canal system. The document outlines the various routes through which root canal infection can develop, such as through exposed dentin tubules or lateral/apical foramina. It also discusses the historical evidence demonstrating the role of bacteria in endodontic disease and pulpal pathology. Spatial distribution of microbiota within the root canal system and the development of endodontic biofilms are addressed.
periodontitis associated with endodontic lesionsParth Thakkar
Periodontitis can be associated with endodontic lesions through several pathways connecting endodontic and periodontal tissues. Anatomical pathways like accessory canals, exposed dentinal tubules, and enamel-cementum disjunction allow bacteria and their byproducts to travel between the pulp and periodontium. Lesions can originate from either a primary endodontic or periodontal problem, with the other area becoming secondarily involved. It is important to diagnose the origin of combined lesions to determine the proper treatment sequence.
Endo perio lesion an interdisciplinary approach to solve the dilemma of which...Shruti Maroo
This document discusses endo-perio lesions, which involve both endodontic (pulp) and periodontal (gum) tissues. It presents a case study of a 34-year-old patient with pain and swelling in their lower right back molar. Diagnostic tests revealed both pulpal and periodontal involvement. The patient underwent root canal treatment followed by subgingival scaling and curettage in the same appointment. Follow-up showed resolution of the abscess and reduced probing depths, indicating the combined treatment was effective for this endo-perio lesion. In conclusion, sequential endodontic and periodontal therapies are important to fully address such lesions.
1) Dental infections can spread from the teeth and oral tissues to other areas if not properly treated. This can lead to serious complications.
2) Common areas of spread include the paranasal sinuses through direct contact, as well as through the bloodstream to distant sites like the heart or brain.
3) Symptoms of spread can include sinus pain and pressure, as well as potentially life-threatening conditions like infective endocarditis or cavernous sinus thrombosis. Prompt treatment is important to prevent further complications.
Similar to Et2 articulo 2 periodontal abscess 20190818214259 (20)
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
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1. REVIEW ARTICLE
DentistrySection
Periodontal Abscess:
A Review
ABSTRACT
INTRODUCTION
Periodontal abscess is the third most frequent dental emergen-
cy, representing 7–14% of all the dental emergencies. Numerous
aetiologies have been implicated: exacerbations of the existing
disease, post-therapy abscesses, the impaction of foreign ob-
jects, the factors altering root morphology, etc.
The diagnosis is done by the analysis of the signs and symptoms
and by the usage of supplemental diagnostic aids. Evidences
suggest that the micro-flora which are related to periodontal ab-
scesses are not specific and that they are usually dominated by
gram-negative strict anaerobe, rods, etc.
The treatment of the periodontal abscess has been a challenge
for many years. In the past, the periodontal abscess in peri-
odontal diseased teeth was the main reason for tooth extrac-
tion. Today, three therapeutic approaches are being discussed
in dentistry, that include, drainage and debridement, systemic
antibiotics and periodontal surgical procedures which are ap-
plied in the chronic phase of the disease.
The localization of the acute periodontal abscess and the possi-
bility of obtaining drainage are essential considerations for suc-
cessful treatment.
Several antibiotics have been advocated to be prescribed in
case of general symptoms or if the complications are suspect-
ed. Antibiotics like Penicillin, Metronidazole, Tetracyclines and
Clindamycin are the drugs of choice.
Periodontium’ is the general term that describes the tissues that
surround and support the tooth structure. The periodontal tissues
include the gums, the cementum, the periodontal ligament and
the alveolar bone. Among several acute conditions that can occur
in periodontal tissues, the abscess deserves special attention. Ab-
scesses of the periodontium are localized acute bacterial infections
which are confined to the tissues of the periodontium. Abscesses
of the periodontium have been classified primarily, based on their
anatomical locations in the periodontal tissue.There are four types
[1] of abscesses which are associated with the periodontal tissues:
1) a gingival abscess which is a localized, purulent infection that in-
volves the marginal gingiva or the interdental papilla; 2) pericoronal
abscesses which are localized purulent infections within the tissue
surrounding the crown of a partially erupted tooth; 3) combined
periodontal/ endodontic abscesses are the localized, circumscribed
abscesses originating from either the dental pulp or the periodontal
tissues surrounding the involved tooth root apex and/or the apical
periodontium and 4) periodontal abscesses which are localized
purulent infections within the tissue which is adjacent to the peri-
odontal pocket that may lead to the destruction of the periodontal
ligaments and the alveolar bone. These are also known as lateral
periodontal abscesses or parietal abscesses.
Among all the abscesses of the periodontium, the periodontal
abscess is the most important one, which often represents the
chronic and refractory form of the disease [1]. It is a destructive pro-
cess occurring in the periodontium, resulting in localized collections
of pus, communicating with the oral cavity through the gingival sul-
cus or other periodontal sites and not arising from the tooth pulp.
The important characteristics of the periodontal abscess include: a
localized accumulation of pus in the gingival wall of the periodon-
tal pockets; usually occurring on the lateral aspect of the tooth;
the appearance of oedematous red and shiny gingiva; may have a
dome like appearance or may come to a distinct point.
Depending on the nature and course of the periodontal abscess, an
immediate attention is required to relieve pain and systemic com-
plications. Moreover, the presence of an abscess may also modify
the prognosis of the involved tooth and in many cases, may be
responsible for its removal. Therefore, accurate diagnosis and the
immediate treatment of the abscesses are the important steps in
the management of patients presenting with such abscesses. This
review focuses on the classification of periodontal abscesses and
discusses their aetiology and clinical characteristics with manage-
ment in clinical practice.
[Table/Fig 1]
PREVALENCE
The prevalence of periodontal abscess is relatively high, which is
often the reason why a person seeks dental care. Periodontal ab-
scess accounts for 6% - 14% of all dental emergencies [2].
Key Words: Periodontal abscess, Incision and drainage, Antibiotics, Gingival pain
[Table/Fig 1]: Periodontal abscess in relation to upper left central incisor
PUNIT VAIBHAV PATEL, SHEELA KUMAR G, AMRITA PATEL
2. It is the third most common [2] dental emergency [1st is Pulpal
infection (14%-25%), followed by pericoronitis (10%-11%)].Among
all emergency dental conditions, periodontal abscesses represent
approximately 8% of all dental emergencies in the world [2], and up
to 14% in the USA.[3-5]
CLASSIFICATION [1],[2]
Classification based on aetiological criteria
1.
2.
Classification based on the course of the disease
Classification based on number
1. Single abscess:Abscess confined to a single tooth.
2. Multiple abscesses:Abscess confined to more than one tooth.
MICROBOLOGY
Streptococcus viridans is the most common isolate in the exudate
of periodontal abscesses when aerobic techniques are used. It has
been reported that the microorganisms that colonize the periodon-
tal abscesses are primarily Gram negative anaerobic rods.Although
they are not found in all cases of periodontal abscesses, high fre-
quencies of Porphyromonas gingivalis, Prevotella intermedia, Fu-
sobacterium nucleatum, Campylobacter rectus, and Capnocyto-
phaga spp have been reported [13].
Actinobacillus actinomycetemcomitans is not usually detected. The
disappearance of Porphyromonas gingivalis from the abscessed
sites after treatment suggests a close association of this microor-
ganism with abscess formation.
Spirochetes have been found as the predominant cell type in
periodontal abscesses when assessed by darkfield microscopy.
00Strains of Peptostreptococcus, Streptococcus milleri (S. angi-
nosus and S. Inter medius), Bacteroides capillosus, Veillonella, B.
fragilis, and Eikenella corrodens have also been isolated.
Overall, studies have noted that the microbiotas found in abscesses
are similar to those in deep periodontal pockets.
The culture studies of periodontal abscesses have revealed a
high prevalence of the following bacteria:
1. Porphyromonas gingivalis-55-100% (Lewis et al [6])
2. Prevotella intermedia- 25-100% (Newman and Sims [7])
3. Fusobacterium nucleatum -44-65% (Hafstrom et al [8])
4. Actinobacillus actinomycetemcomitans-25% (Hafstrom et al[8])
5. Camphylobacter rectus- 80% (Hafstrom et al [8])
6. Prevotella melaninogenica-22% (Newman and Sims [7])
[Table/Fig 2].
PATHOGENESIS
After the infiltration of pathogenic bacteria to the periodontium, the
bacteria and/or bacterial products initiate the inflammatory pro-
cess, consequently activating the inflammatory response. Tissue
destruction is caused by the inflammatory cells and their extracel-
lular enzymes. An inflammatory infiltrate is formed, followed by the
destruction of the connective tissue, the encapsulation of the bac-
terial mass and pus formation. The lowered tissue resistance and
the virulence as well as the number of bacteria present, determine
the course of infection. The entry of bacteria into the soft tissue wall
initiates the formation of the periodontal abscess.
[Table/Fig 3]
PREDISPOSING FACTORS [1]
Different predisposing factors have been proposed, that may act to
develop an abscess. The factors are as follows:
Punit V Patel, et al, Periodontal Abscess www.jcdr.net
Journal of Clinical and Diagnostic Research. 2011 Apr, Vol-5(2):404-409 405
Periodontitis related abscess: When acute infections originate
from a biofilm ( in the deepened periodontal pocket)
Non-Periodontitis related abscess: When the acute infections
originate from another local source. eg. Foreign body impac-
tion, alteration in root integrity
Acute periodontal abscess: The abscess develops in a short
period of time and lasts for a few days or a week. An acute
abscess often presents as a sudden onset of pain on biting and
a deep throbbing pain in a tooth in which the patient has been
tending to clench. The gingiva becomes red, swollen and ten-
der. In the early stages, there is no fluctuation or pus discharge,
but as the disease progresses, the pus and discharge from the
gingival crevice become evident. Associated lymph node en-
largement maybe present.
Chronic periodontal abscess: This is the condition that lasts
for a long time and often develops slowly. In the chronic stages,
a nasty taste and spontaneous bleeding may accompany dis-
comfort. The adjacent tooth is tender to bite on and is some-
times mobile. Pus may be present as also may be discharges
from the gingival crevice or from a sinus in the mucosa overlying
the affected root. Pain is usually of low intensity.
1.
2.
[Table/Fig 3]: Draining exudate after application of digital pressure
Changes in the composition of the microflora, bacterial viru-
lence or in host defences could also make the pocket lumen
inefficient to drain the increased suppuration.[11]
Closure of the margins of the periodontal pockets may lead
to the extension of the infection into the surrounding tissues,
due to the pressure of the suppuration inside the closed pock-
et. Fibrin secretions leading to the local accumulation of pus,
may favour the closure of the gingival margin to the tooth sur-
face.[12]
Tortuous periodontal pockets are especially associated with
furcation defects. These can eventually become isolated and
can favour the formation of an abscess
After procedures like scaling where the calculus is dislodged
and pushed into the soft tissue. It may also be due to inad-
1.
2.
3.
4.
[Table/Fig 2]: Radiographic evidence of periodontal abscess involving lat-
eral and periapical area of involved tooth
3. The iatrogenic factors which are associated with periodontal
abscess
DIAGNOSIS
The diagnosis of a periodontal abscess is usually based on the
chief complaint and the history of the presenting illness. Usually,
the severity of the pain and distress will differentiate an acute from
a chronic abscess. The relevant medical and dental history is man-
datory for the proper diagnosis of such cases.
The important point to be considered while taking the history
includes:
a. General examination
i. Systemic status of the patient
ii.
b. Extra oral examination includes
i. Checking the symmetry of the face, for swelling, rednesss,
fluc tuance, sinus, trismus and examination of cervical lymph
nodes.
c. Intra oral examination includes
i. Examination of the oral mucosa and dentition
www.jcdr.net Punit V Patel, et al, Periodontal Abscess
Journal of Clinical and Diagnostic Research. 2011 Apr, Vol-5(2):404-409406
ii. Checking for gingival swelling, redness and tenderness.
iii. Checking for suppuration, either spontaneous or draining
on pressure or from the sinus.
iv. Checking for mobility and elevation and for tooth which is
tender to percussion.
v. Evaluation of the status of the oral hygiene
vi. Examination of the periodontium including periodontal
screening.
Following examination the next step is to confirm the clinical find-
ings and the findings can be confirmed by supplemental ‘a’ diag-
nostic method that includes radiographs, pulp vitality test, microbial
test, lab finding and others.
[Table/Fig 4]
RADIOGRAPHS [2],[13],[15]
There are several dental radiographical techniques which are avail-
able (periapicals, bitewings and OPG) that may reveal either a
normal appearance of the interdental bone or evident bone loss,
ranging from just a widening of the periodontal ligament space to
pronounced bone loss involving most of the affected cases.
Intra oral radiographs, like periapical and vertical bite-wing views,
are used to assess marginal bone loss and the perapical condition
of the tooth which is involved. A gutta percha point which is placed
through the sinus might locate the source of the abscess.
THE PULP VITALITY TEST [2],[13],[15]
The Pulp vitality test, like thermal or electrical tests, could be used
to assess the vitality of the tooth and the subsequent ruling out of
the concomitant pulpal infections.
MICROBIAL TESTS [2],[12],[15]
Samples of pus from the sinus/ abscess or that which is expressed
from the gingival sulcus could be sent for culture and for sensitivity
tests. Microbial tests can also help in implementing the specific
antibiotic courses.
LAB FINDINGS [2],[15]
Lab tests may also be used to confirm the diagnosis. The elevated
numbers of the blood leukocytes and an increase in the blood neu-
trophils and monocytes may be suggestive of an inflammatory re-
sponse of the body to bacterial toxins in the periodontal abscess.
OTHERS
Multiple periodontal abscesses are usually associated with in-
creased blood sugar and with an altered immune response in dia-
betic patients.
Therefore, the assessment of the diabetic status through the test-
ing of random blood glucose, fasting blood glucose or glycosylated
haemoglobin levels is mandatory to rule out the aetiology of the
periodontal abscess.
[Table/Fig 5], [Table/Fig 6]
equate scaling, which will allow the calculus to remain in the
deepest pocket area, while the resolution of the inflammation at
the coronal pocket area will occlude the normal drainage, and
the entrapment of the subgingival flora in the deepest part of
the pocket and then cause abscess formation.[13]
Periodontal abscesses can also develop in the absence of peri-
odontitis, due to the following causes:
Impaction of foreign bodies (such as a piece of dental floss,
a popcorn kernel, a piece of a toothpick, fishbone, or an un-
known object)
Infection of lateral cysts,
Local factors affecting the morphology of the root may predis-
pose to periodontal abscess formation. (The presence of cer-
vical cemental tears has been related to rapid progression of
periodontitis and the development of abscesses).
5.
a.
b.
c.
Post non-surgical therapy periodontal abscess (Abscess may
occur during the course of active non-surgical therapy)
Post scaling periodontal abscess. eg. Due to the presence of a
small fragment of the remaining calculus that may obstruct the
pocket entrance or when a fragment of the calculus is forced
into the deep, non-inflamed portion of the tissue
Post surgical periodontal abscess
When the abscess occurs immediately following periodontal
surgery. It is often due to the incomplete removal of the sub-
gingival calculus
Perforation of the tooth wall by an endodontic instrument.
The presence of a foreign body in the periodontal tissue (eg.
Suture / pack)
Post antibiotic periodontal abscess [14]
Treatment with systemic antibiotics without subgingival de-
bridement in patients with advanced periodontis may cause
abscess formation.
a.
b.
c.
a.
a.
1.
2.
3.
1.
2.
3.
4.
Examination of features that may indicate on-going systemic
diseases, competency of the immune system, extremes of
age, distress, and fatigue.
Whether the patient is under the care of a physician or a den-
tist
Whether the patient is presently on any medication or whether
he/she has any medical condition that may affect the periodon-
tal diagnosis or treatment.
Any previous dental treatment that may affect the diagnosis or
the treatment plan
The smoking history is important because heavy smokers can
develop a more severe periodontal disease and they do not
respond very well to treatment.
Following taking the proper history, the next important step is
to examine the patient and the lesion. The steps in examination
include:
[Table/Fig 4]: Placement of sulcular incision using #11 surgical blade
4. DIFFERENTIAL DIAGNOSIS
The differential diagnosis of the periodontal abscess is a clinically im-
portant step that allows the dentist to: more clearly understand the
condition or circumstance; assess reasonable prognosis; eliminate
any imminently life-threatening conditions (Ludwig’s angina, space
infections of the orofacial regions); plan treatment or intervention
for the condition or circumstance and enable the patient and the
family to integrate the condition or circumstance into their lives, until
the condition or circumstance may be ameliorated, if possible. The
periodontal abscess should be differentiated (ruled out) from the
following similar conditions and lesions.
[Table/Fig 7], [Table/Fig 8]
GINGIVAL ABSCESS
Features that differentiate the gingival abscess from the periodontal
abscess are:
i. History of recent trauma;
ii. Localisation to the gingiva;
iii. No periodontal pocketing
PERIAPICAL ABSCESS
Periapical abscess can be differentiated by the following features:
i. Located over the root apex
ii. Non-vital tooth, heavily restored or large filling
iii. Large caries with pulpal involvement.
iv. History of sensitivity to hot and cold food
v. No signs / symptoms of periodontal diseases.
vi. Periapical radiolucency on intraoral radiographs.
PERIO-ENDO LESION
The Perio-endo lesion usually shows:
i. Severe periodontal disease which may involve the furcation
ii. Severe bone loss close to the apex, causing pulpal infection
iii. Non-vital tooth which is sound or minimally restored
ENDO-PERIO LESION
Endo-perio lesion can be differentiated by:
i. Pulp infection spreading via the lateral canals into the perodon
tal pockets.
ii. Tooth usually non-vital, with periapical radiolucency
iii. Localised deep pocketing
CRACKED TOOTH SYNDROME
Cracked tooth Syndrome can be differentiated by:
i. History of pain on mastication
ii. Crack line noted on the crown.
iii. Vital tooth
iv. Pain upon release after biting on cotton roll, rubber disc or
tooth sleuth
v. No relief of pain after endodontic treatment
ROOT FRACTURE
Root fracture can be differentiated by the presence of
i. Heavily restored crown
ii. Non-vital tooth with mobility
iii. Post crown with threaded post
iv. Possible fracture line and halo radiolucency around the root
which are visible in periapical radiographs
v. Localised deep pocketing, normally one site only
vi. Might need an open flap exploration to confirm diagnosis
TREATMENT
The treatment of the periodontal abscess does not differ substan-
tially from that of other odontogenic infections. The principles for
Punit V Patel, et al, Periodontal Abscess www.jcdr.net
Journal of Clinical and Diagnostic Research. 2011 Apr, Vol-5(2):404-409 407
[Table/Fig 5]: Performing curettage using surgical curette to remove gran-
ulation tissue from subgingival pocket
[Table/Fig 7]: Post-operative view after 2 weeks. Note the receded and
shrunk ginigva in healing gingival tissue
[Table/Fig 6]: Post-operative (7 days) view after surgical drainage and ap-
plication of topical antimicrobial agent (ozonated oil)
[Table/Fig 8]: Post-operative view after 3 months. Note the receded and
shrunk ginigva after complete healing of gingival tissue.
5. the management of simple dental infections are as follows: [2],[13]
1. Local measures
i. Drainage
ii. Maintain drainage
iii. Eliminate cause
2. Systemic measures in conjunction with the local mea-
sures
The management of a patient with periodontal abscess can divided
into three stages: [2],[13],[15]
i. Immediate management
ii. Initial management
iii. Definitive therapy
IMMEDIATE MANAGEMENT
Immediate management is usually advocated in life-threatening in-
fections which lead to space infections of the orofacial regions or
to diffuse spreading infections (facial cellulites). Hospitalization with
supportive therapy, together with intravenous antibiotic therapy, is
usually recommended. However, depending on the severity of the
infection and the local signs /symptoms, the clinical examination
and the investigations and the initial therapy can be delayed to
some extent. In non-life threatening conditions, systemic measures
such as oral analgesics and antimicrobial chemotherapy will be
sufficient to eliminate the systemic symptoms and severe trismus,
if present.
Antibiotics are prescribed empirically before the microbiological
analysis and before the antibiotic sensitivity tests of the pus and
tissue specimens. [2],[13],[14][15],[16] The empirical regimens are
dependent on the severity of the infection.
The common antibiotics which are used are:
1. Phenoxymethylepenicillin 250 -500 mg qid 5/7 days
2. Amoxycillin 250 - 500 mg tds 5-7 days
3. Metronidazole 200 - 400 mg tds 5-7 days
If allergic to penicillin, these antibiotics are used:
1. Erythromycin 250 –500 mg qid 5-7 days
2. Doxycyline 100 mg bd 7-14 days
3. Clindamycin 150-300 mg qid 5-7 days
INITIAL THERAPY
The initial therapy is usually prescribed for the management of acute
abscesses without systemic toxicity or for the residual lesion after
the treatment of the systemic toxicity and the chronic periodontal
abscess. [2],[13],[16] Basically, the initial therapy comprises of:
a. The irrigation of the abscessed pocket with saline or antise-
ptics
b. When present, the removal of foreign bodies
c. Drainage through the sulcus with a probe or light scaling of
the tooth surface
d. Compression and debridement of the soft tissue wall
e. Oral hygiene instructions
f. Review after 24-48 hours; a week later, the definitive treament
should be carried out.
The treatment options for periodontal abscess under initial
therapy
1. Drainage through pocket retraction or incision
2. Scaling and root planning
3. Periodontal surgery
4. Systemic antibiotics
5. Tooth removal
1. Drainage through the periodontal pocket
Drainage through the pocket is the treatment of choice if the ab-
scess is not complicated by other factors. The steps in surgical
drainage through the periodontal pocket have been demonstrated
in the figures 1 to 8. In general, the steps in the drainage through
the pocket include: [2],[13],[15],[16]
1. Topical / local anaesthesia (nerve block is preferred)
2. The pocket wall is gently retracted with a probe / curette in an
attempt to create an initial drainage through the pocket
entrance
3. Gentle digital pressure is applied
4. Irrigation may be used to express the exudates and to clear the
pocket
5. If the lesion is small and has good access, scaling and curetta-
ge may be undertaken
6. If the lesion is large and drainage cannot be established, scal
ing/curettage and surgery is delayed until the major clinical
signs have been resolved after antibiotic therapy.
7. In such patients, the use of systemic antibiotics with short
term, high dose regimens is recommended
8. Antibiotic therapy alone, without subsequent drainage and
subgingival scaling is contraindicated
2. Drainage through an external incision
However, if the lesion is sufficiently large, pin-pointed and fluctuat-
ing, an external incision can be made to drain the abscess. The
steps are as follows[2],[13],[15],[16]
a. Abscess dried, isolated with gauze sponge
b. Local anaesthesia (nerve block is preferred)
c. A vertical incision done through the most fluctuant centre of the
abscess with a #15 or # 11 surgical blade
d. The tissue which is lateral to the incision is separated with a
periosteal elevator / curette
e. Light digital pressure applied with moist gauze pad
f. In patients with abscess, with marked swelling, tension and
pain, it is recommended to use systemic antibiotics as the
only initial treatment in order to avoid the damage to the hea-
lthy periodontium
g. In such conditions, once the acute condition has receded,
mechanical debridement including root planning is performed
h. Once the bleeding and the suppuration have ceased, the
patient may be dismissed
Post treatment instructions [2],[13],[15],[16]
a. Frequent rinsing with warm salt water
b. Periodic application of chlorhexidine gluconate (either rinsing/
cleaning locally with a cotton tipped swab)
c. Reduce exertion and increase fluid intake
d. Analgesics for patient comfort
e. Repair potential for acute periodontal abscess is excellent
f. Gingiva returns to normal within 6 to 8 weeks
g. Gentle digital pressure may be sufficient to express the purul-
ent discharge.
3. Periodontal surgery [2],[12],[16]
1. Surgical therapy (either gingivectomy or flap procedures) has
also been advocated mainly in abscesses which are associated
with deep vertical defects, where the resolution of the abscess
may only be achieved by a surgical operation.
2. Surgical flaps have also been proposed in cases in which the
calculus is left subgingivally after the treatment.
3. The main objective of the therapy is to eliminate the remaining
calculus and to obtain drainage at the same time.
4. A therapy, with a combination of an access flap with deep scal-
ing and irrigation with chlorhexidine, has also been proposed.
5. As an adjunct to conservative treatment, soft laser therapy
could be used to decrease the pain and swelling of the gingiva
4. Systemic antibiotics with or without local drainage[2],[13],
[15],[16]
Antibiotics are the preferred mode of treatment. However, the local
drainage of the abscess is mandatory to eliminate the aetiologic
factors. The recommended antibiotic regimen usually follows the
culture and the sensitive tests. In general, the empirical antibiotics
can be implemented as listed below:
a. Phenoxymethyl penicilln 250-500mg qid 7 – 10 days
b. Amoxycillin/ Augmentin 250- 500 tds 7- 10 days
c. Metronidazole 250mg tds 7 –10 days (Can be combined with
www.jcdr.net Punit V Patel, et al, Periodontal Abscess
Journal of Clinical and Diagnostic Research. 2011 Apr, Vol-5(2):404-409408
6. amoxycillin. The use of metronidazole is contraindicated in
pregnant patients/ consumption of alcohol)
d. Tetracycline HCl 250mg qid 7-14 days
e. Doxycyline 100mg bd 7-14 days (the use of tetracycline is
contraindicated in pregnant patients and in children below
10 yrs)
5. Extraction of the teeth
Extraction of the tooth is the last resort to treat the periodontal
abscess. However, there are certain guidelines for assessing poor/
hopeless prognosis before extracting the tooth. [2],[15],[16] The
guidelines are as follows
a. Horizontal mobility more than 1mm.
b. Class II-III furcation involvement of a molar.
c. Probing depth > 8 mm.
d. Poor response to therapy.
e. More than 40% alveolar bone loss.
DEFINITIVE TREATMENT
The treatment following reassessment after the initial therapy is to
restore the function and aesthetics and to enable the patient to
maintain the health of the periodontium. Definitive periodontal treat-
ment is done according to the treatment needs of the patient.
CONCLUSIONS
The occurrence of periodontal abscesses in patients who are under
supportive periodontal treatment has been frequently described.
Early diagnosis and appropriate intervention are extremely impor-
tant for the management of the periodontal abscess, since this
condition can lead to the loss of the involved tooth. A single case of
a tooth diagnosed with periodontal abscess that responds favour-
ably to adequate treatment does not seem to affect its longevity. In
addition, the decision to extract a tooth with this condition should
be taken, while taking into consideration, other factors such as the
degree of clinical attachment loss, the presence of tooth mobility,
the degree of furcation involvement, and the patient’s susceptibility
to periodontitis due to the associated systemic conditions.
REFERENCES:
[1]
[2]
[3]
[5]
[4]
[6]
[7]
NAME, ADDRESS, TELEPHONE, E-MAIL ID OF THE
CORRESPONDING AUTHOR:
Dr.Punit Vaibhav Patel, Dept of Periodontology
JSS Dental College & Hospital, Mysore-15 Karnataka, India
Email: punitvai@gmail.com, Phone: 91-9731505109
AUTHORS:
1. Dr. PUNIT VAIBHAV PATEL
Date of Submission: Dec 24, 2010
Peer Review Completion: Jan 05, 2011
Date of Acceptance: Jan 10, 2011
Date of Final Publication: Apr 11, 2011
DECLARATION ON COMPETING INTERESTS: No competing
Interests
2. Dr. SHEELA KUMAR G
3. Dr. AMRITA PATEL
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*Dept of Periodontology, JSS Dental College & Hospital
Mysore-15 Karnataka, India
†Kalindi Oro Care, Varanasi, Uttar Pradesh, India
NAME OF DEPARTMENT(S) / INSTITUTION(S) TO WHICH
THE WORK IS ATTRIBUTED:
Punit V Patel, et al, Periodontal Abscess www.jcdr.net
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