Good . Yawn !!!! .

Morning
As a Dentist, what are your real goals?
??????
To Get Respect from patients !!!!
And to do this ..
We Need To Know Properly

Extractions

Root Canal Treatment

Aesthetic Works (composite)

Implants, FPD & CD

And
PERIODONTAL
ABSCESS
INTRODUCTION:-

Acute lesion- Rapid destruction of tooth support

Required immediate care

Odontogenic abscess

Possibility of infection spreding

Third most prevalent emergency infection( 6-7%)

First- Acute dentoalveolar abscess:- 14-25%
Second- Periocoronitis- 10-11%
Acc. To carranza

Abscess in the supporting periodontal tissues along the

lateral aspect of the root

Abscess in the soft tissue wall of a deep periodontal

pocket

Definition: A periodontal abscess is a localized purulent

infections in the periodontal tissues.
 An acute, destructive process in the periodontium resulting
in localized collection of pus communicating with the oral
cavity through the gingival sulcus or other periodontal sites
& not arising from the tooth pulp.
(Ranny- 1977)
CLASSIFICATION

MENG-1999

Gingival Abscess

Periodontal Abscess

Pericoronal Abscess
Depending on the abscess location

Gingival abscess :- only marginal & interdental

gingiva

Periodontal abscess :- affect deeper periodontal

structures
Depending on the course of the lesion

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.

Chronic abscesses may produce a dull pain and may at

times become acute.
(Carranza & Newman, 1996)
Depending on the number

Single periodontal abscess

Multiple periodontal abscess

Depending on the cause of acute infectious
process

Periodontitis-related abscess:- Originates from

biofilm.

Non- Periodontitis-related abscess:- originates from

other local factors.
ex: foreign body impaction, alteration
in the root integrity
Gingival Abscess
Definition:

A localized purulent infection that involves the

marginal gingiva or interdental papilla

Abscess localized in the gingiva caused by injury to the

outer surface of the gingiva & not involving the
supporting structures are called gingival abscess.
(Carranza)
 Etiology
Acute inflammatory response to foreign substances
forced into the gingiva

Clinical Features
Localized swelling of marginal gingiva or papilla

A red, smooth, shiny surface

May be painful and appear pointed

Purulent exudate may be present

No previous periodontal disease

Gingival Abscess
 Treatment

Elimination of foreign object.

Through careful debridment.
Drainage through sulcus with probe or light scaling /
incision through fluctuant area.
Rinsing with warm saline every 2 hrs.
Follow-up after 24-48 hours.
Periodontal abscess
Etiology

A) Periodontits related abscess :

Different mechanisms are

Exacerbation of a chronic lesions
Post- therapy periodontal abscess
ex: post scaling, post surgery, antibiotic
therapy
Post scaling
B) Non-periodontitis related abscess

Impaction of foreign bodies

Tooth perforation by endodontic
instruments
Infection of lateral cyst
Morphology of tooth root may predispose
 Etiology:-
1) Tortuous periodontal pockets especially associated with
furcation defects

2) Closure of margins of periodontal pockets

Extension of the infection into the surrounding tissue

Fibrin secretions local accumulation of pus

favour the closure of gingival margin to

the tooth surface
3) Changes in composition of the microflora, bacterial
virulence or in host defenses

Make the pocket lumen inefficient to drain

4) Impaction of foreign bodies

5) After procedures like scaling

Dislodged calculus Resolution of coronal pocket

into soft tissue inflammation area
6) Systemic antibiotics without subgingival debridement

7) Perforation of the lateral wall of a tooth by an endodontic

instrument

8) Local predisposing factors for periodontal abscess

formation: ----
a) External root resorption
b) Invaginated tooth
9) Cracked tooth

10) Local factors affecting morphology of roots such as

cemental tears
Clinical features:-

General Extra-oral Intra-oral

Symmetry of face
Presence of systemic Swelling,
toxicity e.g. Redness
Increase in body Sinus
temperature and trismus
malaise Examination of cervical lymph
nodes
 Intra-oral

Smooth, shiny swelling of the gingiva

Painful, tender to palpation
Purulent exudate
Increased probing depth
Mobile and/or percussion sensitive
Tooth usually vital
Periodontal abscess-fluctuant Pd. Abscess irt 46 (furcation involved)

Diffuse swelling on buccal side of the molar irt 37

46(distal surface)-spontaneous Tooth extrusion & increased
suppuration through pocket mobility Irt - 18

Chronic pd abscess irt 33

with fistulous tract
opening (GP point used)
X-ray taken with GP points

Periodontal
pockets present
Radiolucent area
on lateral surface
Widening of
pd.lig space
 Microbology of periodontal abscess

Gram-negatives predominated over gram-positive and rods

over cocci

Polymicrobial and usually caused by endogenous bacteria

Strict anaerobes- 6O%

 Porphyromonas gingivalis-55-100%

Prevotella intermedia- 25-100%

Fusobacterium nucleatum -44-65%

Actinobacillus actinomycetemcomitans-25%

Camphylobacter rectus- 80%

 Pathogenesis and Histopatholgy

Contains bacteria, bacterial products, inflammatory cells,

tissue breakdown products and serum

Occlusion or trauma to the orifice of the periodontal pocket

Extension of the infection from the pocket into the soft

tissues of the pocket wall
Investigations:

History
Examination
Vitality test
Radiograph to include periapical
Diagnosis
Van Winkelhoff et al (1985) diagnostic criteria

Association of pocket of >/= 6 mm,

Presence of bleeding on probing,
Evidence of radiographic bone loss &
Absence of periapical lesion.
 Periodontal Vs. Periapical Abscess
Periodontal Abscess Periapical Abscess
Vital tooth Non-vital tooth

No caries Caries

Pocket No pocket

Lateral radiolucency Apical radiolucency

Mobility No or minimal mobility

Percussion sensitivity Percussion sensitivity

variable Sinus tract opens via
Sinus tract opens via alveolar mucosa
keratinized gingiva
The purpose of treatment of acute periodontal
abscess is to:

1. Alleviate pain,

2. Control the spread of infection, and

3. To establish drainage

Treatment of choice for a chronic periodontal abscess

is by a flap procedure.
Protocol recommended

1. Incision & drainage(closed or open

approach)
2. Scaling & root planing
3. Compression & debridment of soft tissue
wall
4. Use of different systemic administered
antibiotics.
5. Tooth extraction.
Complications

1. Tooth loss

2. Dissemination of infection