22. Periodontal abcesses

Question 1

Periodontal abscess definition

Answer 1

Localised purulent inflammation of periodontal tissues

Question 2

Types of abscess

Answer 2

• Gingival abscess-marginal gingiva and interdental tissues
• Periodontal abscess-infection localised to periodontal pocket and may result in destruction of PDL and alveolar bone
• Pericoronal abscess- associated w/ crown of partially erupted tooth
• Acute
• Chronic

Question 3

Clinical presentation of gingival abscess

Answer 3

• Localised acute inflammatory lesion
• Red, smooth and sometimes painful swelling
• Aetiology-Plaque, trauma, foreign body impaction

Involves marginal and interdental gingiva

Question 4

Clinical presentation of Periodontal abscess

Answer 4

• In patients w/ untreated periodontitis
• Major cause of tooth loss
• Can occur-> after periodontal surgery, due to recurrent disease, Tooth perforation and foreign body impaction
• Diabetes predisposing factor

Question 5

Clinical presentation of Pericoronal abscess

Answer 5

• Inflammation of soft tissue operculum covering partially erupted tooth
• Commonly mandibular 3rd molars
• Aetiology-plaque, food impaction, trauma

Question 6

Periodontal abscesses

Acute abscess

Answer 6

• Exacerbation of chronic inflammatory periodontal lesion
• Influencing factors-Increased no. and virulence of bacteria, lowered tissue resistance and lack of spontaneous drainage
• Painful red, edematous swelling of gingival tissues
• Exudate expressed w/ gentle press
• Tooth sensitive to percussion and feel elevated in socket

Drainage may be affected by deep pocket morphology, debris

Question 7

Periodontal abscess

Chronic abscess

Answer 7

• Forms after spreading infection controlled by spontaneous drainage, host response or therapy
• Hemostasis exists between host and infection
• Little to no symptoms
• May be dull pain, inflammation and fistulous tract
• Tooth may be slightly elevated

Usually no systemic involvement

Question 8

Reasons for antibiotic therapy in patient w/ acute abscess

Answer 8

• Cellulitis
• Deep inaccessible pocket
• Fever
• Regional lymphadenopathy
• Immunocompromised patient

Question 9

Antibiotic options for periodontal infections

Answer 9

• Amoxicillin-500mg-1g(loading dose) then 500mg 3 times a day for 3 days->re-evaluation after 3 days
• Penicillin allergy-> clindamycin-600mg loading dose then 300mg 4 times a day for 3 days
• Azithromycin-1g loading dose then 500mg 4 times a day for 3 days

Re-evaluation to dettermine need for continued use

Question 10

Types of drainage of abscesses

Answer 10

• Drainage through periodontal pocket
• Drainage through external incision

Question 11

Drainage through periodontal pocket

Answer 11

• La around abscess
• Pocket access w/ probe or currette to initiate drainage
• Digital pressure and irrigation to express exudate
• Use of antibiotics

Debridement, scaling, root planning, surgical access avoided until major clinical signs resolved

Question 12

Drainage through external incision

Answer 12

• Abscess dried and isolated w/ gauze sponges
• La applied
• Vertical incision w/ no.15 through center of abscess
• Exudate expressed and wound edges approximated under light digital pressure
• Antibiotics given

Question 13

Treatment for patients who need systemic antibiotics

Answer 13

• Rinse w/ salt water and use of CHX
• Reduced exertion
• Increased fluid intake
• Analgesics if pain