Periodontal abscess

Periodontal abscess

Cracked tooth lateral periodontal abscess

Periodontal abscess is related directly to a preexisting periodontal pocket. Precipitating factors include subgingival flora, host resistance, or both. When such a pocket reaches sufficient depth, around 5–8 mm, the soft tissues around the neck of the tooth approximate the tooth so tightly that the orifice of the pocket is occluded. Bacteria multiply in the depth of the pocket and cause enough irritation to form an acute abscess with exudation of pus into this area. A foreign body, particularly food debris, may also lead to abscess formation. This may result in enough swelling to destroy the cortical plate of bone, if it still exists, allow the abscess to balloon the overlying tissues, forming a ‘gum boil’, or parulis

Clinical Features

It usually occurs in adults and is rare in children. The most common cause of periodontal abscess is foreign bodies. The acute periodontal abscess will cause the afflicted tooth to be tender to percussion. Pain, foul taste, mobility of the involved tooth, tenderness over the corresponding gingiva, and lymphadenopathy are the other symptoms. Lymph node involvement was also rare. In some cases the only clinical manifestation of the abscess was the release of pus from the neck of a loose deciduous tooth upon pressure. It was noted that the erythrocyte sedimentation rate, which is seldom elevated in normal children with a periodontal abscess, was usually elevated in cortisone treated children with rheumatic fever with a periodontal abscess.

Histologic Features

Microscopically, the abscess resembles an abscess elsewhere. It consists of a central cavity filled with pus walled off on one side by the root of the tooth and on the other by connective tissue; because it is likely that in most instances that the epithelial lining of the crevice would have been destroyed by the inflammatory process.

Treatment

Treatment of a periodontal abscess is similar to that of an abscess elsewhere. A direct incision, perpendicular to the long axis of the involved tooth, releases pus. If the abscess does not drain spontaneously through the gingival crevice, and if it is not treated, a fistula may develop to release the pus spontaneously onto the mucosal surface. Careful insertion of a dull probe into the pocket along the tooth will usually induce drainage, and the acute symptoms will subside. The abscess will recur; however, unless the cause is removed and the depth of the pocket is reduced. Cases in which normal tissue contours cannot be developed and maintained, extraction of the tooth is advised after the acute symptoms have subsided.

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Source: Data courtesy of the U.S. National Library of Medicine. Since the data might have changed, please query MeSH on Periodontal abscess for any updates.

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