Localized, purulent infection within the tissues adjacent to the periodontal pocket that may lead to the destruction of periodontal ligament and alveolar bone
More Likely to Occur
- as an acute exacerbation of untreated chronic periodontitis
- as the consequence of the treatment of chronic periodontitis
- due to foreign body impaction
- due to alterations in the integrity of the root leading to bacteria colonization
- In the presence of a superficial abscess, there is an ovoid elevation of the gingiva along the lateral aspect of the root. A deep periodontal abscess might be less obvious.
- Suppuration, either spontaneous or provoked, through a fistula or from a periodontal pocket
- Tooth mobility and/or elevation
- Regional lymphadenopathy
- Mild discomfort to severe pain
- Sensitivity on palpation and/or percussion on the affected tooth
- Fever and/or malaise
- Inquire about any history of chronic periodontitis and the nature of any recent dental/periodontal interventions.
- Determine the existence of a periodontal pocket (Fig. 1).
- Confirm the presence of purulent exudate.
- Obtain radiographic evidence of bone loss. However, the lack of evident bone loss does not necessarily eliminate the existence of a periodontal abscess.
Based on clinical observations/investigation, a diagnosis of periodontal abscess is determined.
- Periapical abscess
- Lateral periodontal cyst
- Periodontic-endodontic lesion
In case of recurrent abscesses, the following differentials should be considered:
- Squamous cell carcinoma
- Eosynophilic granuloma
- Management of the acute lesion
Systemic antibiotics should be prescribed only when systemic involvement is evident.
- Establish drainage via pocket lumen through subgingival instrumentation of the root surface. In addition, incision of the abscess may be necessary.
- If the abscessed tooth does show advanced attachment loss and its prognosis is poor, extraction should be the recommended course of action.
- Management of the original and/or residual lesion
A referral to the periodontist is usually recommended for stage-two treatment.
- Therapy takes place 7 to 14 days following the management of the acute lesion, and typically includes periodontal flap surgery, particularly in the presence of deep infrabony pockets.