PERIODONTAL ABSCESS

1. Abscesses of the Periodontium

2. Definition:
ABSCESS :
Localized collection of purulent exudate (pus) in a cavity formed by
the disintegration of tissues due to an infectious process or foreign material.
- 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 :
• The 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

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 :
Extension of infection from a periodontal pocket deeply into the supporting
periodontal tissues.
Lateral extension of inflammation from the inner surface of a periodontal pocket.
 Deep and tortuous periodontal pockets, a periodontal abscess may form in the cul-
de-sac.
Incomplete removal of calculus during treatment of a periodontal pocket.
Trauma to the tooth or perforation of the lateral wall of the root in endodontic
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.
 Suspected area should be probed carefully along the gingival margin in
relation to each tooth surface to detect a channel from the marginal area to the
deeper periodontal tissues. Continuity of the lesion with the gingival margin is
clinical evidence that the abscess is periodontal.
Diagnosis :

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

12. Periocoronal Abscess :
• The 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.

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. Treatment of Acute periodontal abscess usually involves two stages
 Management of the acute lesion.
 The appropriate treatment of the original and / or residual lesion, once the
acute situations has been controlled.
Treatment of Periodontal Abscess:

15. The purpose of treatment of acute periodontal abscess is to
 Alleviate pain,
 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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