Periodontal Abscess (also known as Parietal Abscess or Lateral Abscess) is defined as a localized pus collection within the periodontal (gum) tissues. Periodontal abscess is not the same as the more common periapical abscess, which is caused by the spread of infection from an infected tooth. As compared to a periapical abscess, periodontal abscesses are often associated with a living tooth.
What Are The Classification Of Periodontal Abscesses?
Periodontal abscesses can be classified into 4 different types according to the location of the pus formation. Each type of periodontal abscesses is described below:
- Gingival Abscess:
- Gingival abscess is defined as a localized, pus infection involving the soft periodontal (gum) tissues near the interdental papilla or the marginal gingiva of the gum tissue.
- Periodontal Abscess:
- Periodontal abscess is defined as a localized, pus infection involving a greater extent of the periodontal (gum) tissue, spreading apically and close to a periodontal (gum) pocket.
- Pericoronal Abscess:
- Pericoronal abscess is defined as a localized, pus infection within the periodontal (gum) tissue surrounding the crown portion of a partially or fully erupted tooth.
- Pericoronal abscesses are often associated with acute pericoronitis around a partially erupted or impacted tooth (especially lower wisdom tooth).
- Combined Periodontal-Endodontic Abscess
Gingival Abscess – Photo By DRosenbach at en.wikipedia [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons
What Are The Causes Of Periodontal Abscesses?
Most of the time, periodontal abscess occurs as a result of advanced periodontal disease. Dental plaque, bacteria as well as calculus are contained within the periodontal pocket around the teeth. Harmful bacteria continually find their way into the gum tissues, however, these bacteria are often held by the immune system. The formation of periodontal abscess represents the disruption in this balance. When harmful bacteria invade the soft tissue of periodontal pocket, inflammatory response is triggered. When the immune system attempts to isolate the infection from spreading, pus-filled periodontal abscesses result.
The opening of the periodontal pocket provides the communication between the oral environment and the pocket. If the opening of the periodontal pocket is obstructed due to some reasons, the dental plaque and calculus will be trapped within the periodontal pocket. The obstruction of the periodontal pocket can be caused by the deep pocket involvement, furcation involvement, food packing, incomplete dental scaling, and etc.
Other than that, penetration injury to the periodontal tissues may inoculate harmful bacteria into the gum tissues as well. These penetration injuries can be caused by fishbone, toothpick, toothbrush bristle and etc.
Besides that, systemic immune factors can predispose a person to the formation of periodontal abscess as well. For example, patients with diabetes mellitus are more prone to periodontal abscesses.
What Are The Signs & Symptoms Of Periodontal Abscess?
Periodontal abscess is associated with various signs and symptoms. The main sympton is pain (tenderness), which is sudden in onset and worsened by the occlusion of the involved teeth. The teeth associated with periodontal abscesses are felt prominent in the bite as if the teeth have raisen.
The teeth associated with periodontal abscess may become mobile after some time. Other than that, periodontal abscesses could contribute to the destruction of the periodontal tissues as well as the supporting bone around the teeth.
At the early stage of lesion, the oral mucosa covering the periodontal abscess appears swollen, red and painful to touch. The strectching of the mucosa over the abscess can cause the surface of the lesion to be shinny.
After some time, pus accumulates within the lesion. This is associated with increasing pressure and pain within the abscess. Pus accumulates until it drains into the mouth, when this occurs, the patient could perceive a bad smell and bad taste within the mouth. Most of the time, the pus eventually drains through the opening of the periodontal pocket into the mouth.
Periodontal Abscess – Photo By [Coronation Dental Specialty Group] [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons
What Are The Treatments Available For Periodontal Abscess?
The initial management of a periodontal abscess includes pain relief and the control of the infection. This could be achived by the drainage of the pus. If the tooth involved is to be extracted, pus drainage can be done through the extraction socket. If the pus is discharging from the periodontal pocket, pus drainage can be encouraged via soft tissue massage, saline irrigation or dental scaling. If these methods do not work, pus drainage could be done via incision & drainage technique.
Incision & Drainage – Photo By Coronation Dental Specialty Group [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons
Other than that, antibiotics are required as part of the treatment of periodontal abscess. The common oral antibiotics that are being prescribed to the patients with periodontal abscess include Amoxicillin, Clindamycin (for patients who are allergic to Penicillin or pregnant) and/or Metronidazole. The prescription depends on the individual conditions of the patients.
Besides that, the dentist might opt to reduce the height of the involved tooth so that it no longer contacts with the opposing tooth when the patient occludes. By doing so, the pain caused by biting could be relieved. Other measures being taken for the management of periodontal abscess include the use of antiseptic mouthwash, dental scaling and oral hygiene instruction.
If you are in doubt, always consult your dentist for proper diagnosis, management and treatment.
Article written by,
Dr. Wong Kee Cheong (Tommy)
Dental Surgeon
BDS (AIMST), MBA (SEGi), YCDP