Abscess in Periodontology

1. Afternoon ‘Class’

2. Periodontal
Abscess

3. Abscess
• An abscess is a collection of pus that has built up within the tissue of the
body.
• Signs and symptoms of abscesses :
1. Redness,
2. Pain,
3. Warmth,
4. Swelling.
• The swelling may feel fluid-filled when pressed.
Abscess

4. Types of Abscesses in Oral Cavity :
1. Gingival Abscess
2. Periodontal Abscess
3. Peri-coronal Abscess

5. Depending on the abscess location
1. Gingival abscess : Only marginal & interdental gingiva
2. Periodontal abscess : Affect deeper periodontal structures
1. Acute abscesses are painful, edematous, red, shiny, ovoid elevations of the gingival
margin and/or attached gingiva. After their purulent content is partially exuded, they
become chronic.
2. Chronic abscesses may produce a dull pain and may at times become acute.
Depending on the course of the lesion

6. Depending on the Number
1. Single periodontal abscess
2. Multiple periodontal abscess
Acc. To Carranza (9th edition)
1. Abscess in the supporting periodontal tissues along the lateral aspect of the root.
2. Abscess in the soft tissue wall of a deep periodontal pocket.

7. Gingival Abscess
A localized purulent infection that involves the marginal
gingiva or interdental papilla.
‘Or’
When an abscess is confined to the marginal gingiva, it has
been termed as gingival abscess.
(McFall-1964 & O’Brien-1970)

8. Etiology
Acute inflammatory response to foreign substances forced into the gingiva.
Clinical Features
1. Localized swelling of marginal gingiva.
2. A red, smooth, shiny surface.
3. May be painful and appear pointed.
4. Purulent exudate may be present.
5. No previous periodontal disease.

11. 1. Elimination of foreign object.
2. Through careful debridement.
3. Drainage through sulcus with probe or light scaling /
incision through fluctuant area.
4. Rinsing with warm saline every 2 hrs.
5. Follow-up after 24-48 hours.

12. Periodontal
Abscess

15. A periodontal abscess (also termed lateral
abscess, or parietal abscess), is a localized collection
of pus (i.e. an abscess) within the tissues of
the periodontium.
It is a type of dental abscess.
Periodontits – related abscess :
• Different mechanisms are
• Exacerbation of a chronic lesions
• Post- therapy periodontal abscess.
Eg.: post scaling, post surgery, antibiotic therapy
Non-periodontitis – related abscess
• Impaction of foreign bodies.
• Tooth perforation by endodontic instruments.
• Infection of lateral cyst.
• Morphology of tooth root may predispose.

16. Clinical Features
• Smooth, shiny swelling of the gingiva.
• Painful, tender to palpation.
• Purulent exudate.
• Increased probing depth.
• Mobile and/or percussion sensitive.
• Tooth is usually vital.

22. Chronic Periodontal abscess i.r.t 33 : Fistulous tract opening (GP point used)

25. Periodontal abscesses are termed "mixed anaerobic
infections," due to the microbiological findings.
Generally specking, the bacteria found in abscesses are of
similar composition to what is found in the periodontal
pockets.
Microbial findings:

26. Periodontal Abscess
1. Vital tooth
2. No caries
3. Pocket
4. Lateral radiolucency
5. Mobility
6. Percussion : sensitivity +nt/-nt
7. Sinus tract opens via keratinized
gingiva
Peri-apical Abscess
1. Non-vital tooth
2. Caries
3. No pocket
4. Apical radiolucency
5. No or minimal mobility
6. Percussion : sensitivity +nt
7. Sinus tract opens via alveolar
mucosa

27. The purpose of treatment of acute periodontal abscess is to:
1. Alleviate pain.
2. Control the spread of infection.
3. To establish drainage.
Treatment of choice for a chronic periodontal abscess is by a flap
procedure.

28. Protocol Recommended
• Incision & drainage (closed or open approach)
• Scaling & root planing.
• Compression & debridement of soft tissue wall.
• Use of different systemic administered antibiotics.
• Tooth extraction.
• Antibiotics :
 Without penicillin allergy
 Penicillin
 With penicillin allergy
 Azithromycin
 Clindamycin

29. CHRINOC PERIODONTAL ABSCESS- FLAP SURGERY

33. Complications
1.Tooth loss.
2.Recurrent & Radiating Pain.
3.Dissemination of infection.

34. Thank You