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. PERIODONTAL ABSCESS
DR.SHRADDHA KODE

2. Abscess can be defined as the
localised collection of purulent
material collected in a cavity caused
by destruction of tissues
DEFINITION:
Periodontal abscess is a localised
purulent infection in the tissues
adjacent to periodontal pocket
that may lead to the destruction
of periodontal ligament and
alveolar bone.

3. It is also called as the lateral
periodontal abscess or parietal
abscess
Periodontal abscess is the third
most prevalent emergency
infection after acute alveolar
abscess (14-25%) and
pericoronitis (10-11%)

4. Formed as a result of rapidly
growing bacteria within a
periodontal pocket leading to
abscess formation
Periodontal abscess can lead to
complications due to bacteremia
that may cause infection in
distant location

5. Based on the location:
Gingival Abscess – Localized painful
swelling affecting only the marginal and
interdental gingiva. Occurs due to
impaction of foreign objects
Periodontal Abscess – Usually affects
deeper periodontal structures including
deep pockets, furcations and vertical
osseous defects
Pericoronal abscess – Inflammation of
the soft tissue associated with the
crown of partially erupted tooth
CLASSIFICATION:

7. Based on the course of the lesion:
Acute periodontal abscess – sudden
onset of pain on biting and deep
throbbing pain, gingiva appears red,
swollen and tender, as the disease
progresses – pus discharge from
gingival crevice, lymph node
enlargement
Chronic periodontal abscess –
Infection is of prolonged duration and
abscess develops slowly, involved tooth
– mobile and tender, pus discharge or
sinus in the overlying mucosa, pain of
low intensity

8. Based on the number:
Single periodontal abscess –
associated with local factors – plaque,
calculus, anatomic factors
Multiple periodontal abscess –
Associated with uncontrolled diabetes
mellitus, medically compromised
patients, in patients with untreated
periodontitis after systemic antibiotic
therapy

10. Based on the cause:
Periodontitis related abscess - Results
when the acute infection originates
from biofilm present in a deepened
periodontal pocket
Non-periodontitis related abscess -
Results when the acute infection
originates from other local source like
foreign body impaction or alteration
in root integrity

11. IMPORTANT TO REMEMBER
PERIODONTAL
ABSCESS
PERIAPICAL
ABSCESS
Associated with
pre-existing
periodontal
pockets
Associated with
deep restoration,
caries or tooth
wear
Pulp test - Vital Pulp test – Non-
vital
Localised swelling
on the lateral
aspect of the
tooth
Localised swelling
in the apical area

12. IMPORTANT TO REMEMBER
PERIODONTAL
ABSCESS
GINGIVAL
ABSCESS
Involves
supporting
periodontal
structures
Confined to
interdental or
marginal gingiva
Radiograph – bone
loss
Acute
inflammatory
response to the
forcing of foreign
material into the
gingiva. No bone

13. Association with tortuous pockets,
cul-de-sac which eventually become
isolated - represents a period of
active bone destruction
The marginal closure of the
periodontal pocket may lead to an
extension of the infection into the
surrounding periodontal tissues due
to the pressure of the suppuration
inside the closed pocket
CAUSE:

14. Changes in the composition of the
microflora, bacterial virulence or in
host defenses could also make the
pocket lumen inefficient to drain the
increased suppuration
It may also occur as an acute
exacerbation of an untreated
periodontitis, during periodontal
therapy, in refractory periodontitis
cases or during periodontal maintenance

15. Post-scaling periodontal abscess –
dislodegement of calculus or inadequate
scaling
Post-surgery abscess – incomplete
removal of subgingival calculus or
presence of foreign substance
ex.sutures, periodontal dressing
Post-antibiotic abscess – systemic
antibiotics without subgingival
debridement may cause an abscess due
to change in the subgingival microbiota
leading to superinfection and massive
inflammation

16. Impaction of foreign bodies – piece
of dental floss, popcorn kernel,
fishbone, toothpick
Perforation of the tooth wall by an
endodontic instrument
Infection of lateral cysts
WHAT CAN BE THE OTHER
CAUSES?

17. Bacterial entry – first event to initiate
periodontal abscess
Inflammatory cells are then attracted
by the chemotactic factors released by
the bacteria
The concomitant inflammatory reaction
leads to destruction of the connective
tissues, the encapsulation of the
bacterial infection and the production
of pus
PATHOGENESIS:

18. most frequent type of bacteria
were gram-negative anaerobic
rods and gram-positive
facultative cocci

19. Throbbing pain in acute
periodontal abscess and dull
gnawing pain in chronic
Edema and redness
Involved tooth – sensitive to
lateral percussion
Increased mobility
Increased probing depth
CLINICAL FEATURES:

20. Suppuration – spontaneous or on
putting lateral pressure
Draining sinus
Radiographic – bone loss in
chronic cases
Systemic involvement – fever
malaise, lymph node enlargement

21. The purpose for the treatment of acute
periodontal abscess:
Alleviate pain, establish drainage and to
control the spread of infection
Protocol:
Incision and drainage – Closed and open
approach
Scaling and root planing
Debridement of soft tissue wall
Antibiotics
Last resort : Extraction
TREATMENT:

22. a
For the closed approach:
Anesthesia
Flat instrument /probe – carefully
introduce into the pocket
Distend the pocket wall for drainage
Further drain and gently curettage the
mass of tissue internally

23. For the open approach:
Stab incision through the most
fluctuant part of the swelling, extending
to an area just apical to the abscess
Curette the granulomatous tissue
internally
External aspect of the abscess is gently
pushed to drain the remaining pus
Irrigation
Approximate to wound margin

24. The purpose for the treatment of
chronic periodontal abscess:
To eliminate the remaining calculus and to
establish drainage
Mainly where the resolution can be
achieved only by surgical means
(vertical bone loss and deep pockets)
Gingivectomy
Periodontal flap procedures

25. For the treatment of gingival abscess:
Elimination of the foreign object through
careful debridement
Drainage through the sulcus with a probe
or light scaling
For the treatment of pericoronal
abscess:
Debridement of plaque and food debris
under the pericoronal flap
Establish drainage
Irrigation using Povidone iodine solution
Acute phase controlled: Decision
regarding operculectomy or

26. Periodontal abscess is a relatively
common condition in patients with
moderate to deep pockets
Important to differentiate
periodontal abscess from periapical
and gingival abscess
Important to treat the underlying
cause for multiple abscesses
Drainage of the abscess and
removal of the underlying cause is
required to ensure healing
CONCLUSION: