PERIODONTAL ABSCESS

HERRINA FIRMANTINI

TERM
A periodontal abscess is a localized
purulent inflammation in the
periodontal tissues
It is also known as a lateral abscess
or a parietal abscess.

Periodontal abscess formation may

occur in the following ways
1. Extension of infection from a
periodontal pocket deeply into the
supporting periodontal tissues and
localization of the suppurative
inflammatory process along the
lateral aspect of the root.

Periodontal abscess formation may

occur in the following ways
2. Lateral extension of inflammation
from the inner surface of a
periodontal pocket into the
connective tissue of the pocket wall.
Formation of the abscess results
when drainage into the pocket space
is impaired.

Periodontal abscess formation may

occur in the following ways
3. Formation in a pocket with a
tortuous course around the root. A
periodontal abscess may form in the
cul-de-sac, the deep end of which is
shut off from the surface.

Periodontal abscess formation may

occur in the following ways
4. Incomplete removal of calculus
during treatment of a periodontal
pocket. The gingival wall shrinks,
thereby occluding the pocket orifice,
and a periodontal abscess occurs in
the sealed-off portion of the pocket.

Periodontal abscess formation may

occur in the following ways
5. After trauma to the tooth or with
perforation of the lateral wall of the
root in endodontic therapy. In these
situations, a periodontal abscess
may occur in the absence of
periodontal disease.

Periodontal abscesses are classified

according to location as
follows:
1. Abscess in the supporting
periodontal tissues along the lateral
aspect of the root. With this
condition, a sinus generally occurs in
the bone that extends laterally from
the abscess to the external surface.

Periodontal abscesses are

classified according to location as
follows:
2. Abscess in the soft-tissue wall of a
deep periodontal pocket.

CLINICAL EXAMINATION
Periodontal abscesses may be acute
or chronic.

The acute periodontal

abscess
Appears as 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 acute periodontal

abscess
The shape and consistency of the
elevated area vary; the area may be
domelike and relatively firm, or it
may be pointed and soft.
In most cases, exudate may be
expressed from the gingival margin
with gentle digital pressure.

The acute periodontal

abscess
Accompanied by symptoms such as
throbbing, radiating pain, and
tenderness of the gingiva to
palpation.

The acute periodontal

abscess
Other symptoms may include
sensitivity of the tooth to palpation;
tooth mobility and lymphadenitis;
and, less Frequently, systemic effects
such as fever, leukocytosis, and
malaise.

The acute periodontal

abscess
Occasionally the patient may have
symptoms of an acute periodontal
abscess without any notable clinical
lesion or radiographic changes

The chronic periodontal

abscess
usually presents a sinus that opens
onto the gingival mucosa along the
length of the root.
There may be a history of
intermittent exudation.

The chronic periodontal

abscess
The orifice of the sinus may appear
as a difficult-to-detect pinpoint
opening, which, when probed,
reveals a sinus tract that leads deep
into the periodontium.

The chronic periodontal

abscess
The sinus may be covered by a small,
pink, beadlike mass of granulation
tissue.
The chronic periodontal abscess is
usually asymptomatic.

The chronic periodontal

abscess

However, the patient may report

episodes of dull, gnawing pain; a
slight elevation of the tooth; and a
desire to bite down and grind the
tooth.
The chronic periodontal abscess
often
undergoes
acute
exacerbations, with all of the
associated symptoms.

 Diagnosis of the periodontal abscess

requires the correlation of the history
with the clinical and radiographic
findings.

 The 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.

Periodontal Abscess and

Gingival Abscess
The principal differences between
the periodontal abscess and the
gingival abscess are location and
history.
The gingival abscess is confined to
the marginal gingiva, and it often
occurs in previously disease-free
areas.

Periodontal Abscess and

Gingival Abscess
It is usually an acute inflammatory
response to the forcing of foreign
material into the gingiva.
The periodontal abscess involves the
supporting periodontal structures,
and it generally occurs during the
course of chronic destructive
periodontitis.

Periodontal Abscess and

Periapical Abscess
Several characteristics can be used
as guidelines when differentiating a
periodontal abscess from a periapical
abscess.

Periodontal Abscess and

Periapical Abscess
If the tooth is nonvital, the lesion is
most likely periapical. However, a
previously nonvital tooth can have a
deep periodontal pocket that can
abscess.

Periodontal Abscess and

Periapical Abscess
Moreover, a deep periodontal pocket
can extend to the apex and cause
pulpal involvement and necrosis.

Laboratory Aids to Clinical

Diagnosis
When unusual gingival or periodontal
problems are detected that cannot be
explained by local causes, the possibility
of contributing systemic factors must be
explored.
The signs and symptoms of oral
manifestations of systemic disease have
to be clearly understood and analyzed and
their presence discussed with the
patients physician.

 Analyses of blood smears, blood cell

counts, white blood cell differential counts,
and erythrocyte sedimentation rates are
used to evaluate the presence of blood
dyscrasias and generalized infections.
Determinations of coagulation time,
bleeding time, clot retraction time,
prothrombin time, and capillary fragility as
well as bone marrow studies may be
required at times.

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