Abscesses of the Periodontium
An abscess is, quite simply, an accumulation of pus that has collected in a localized area of the body. A periodontal abscess is an abscess within the periodontium, specifically occurring alongside a tooth. This is not to be confused with a periapical abscess, which is an abscess that forms as infection from a dead tooth spreads into the area surrounding the root of the tooth. Periodontal abscesses are acute bacterial infections that are associated with living teeth.
The main symptom of periodontal abscesses is deep, throbbing pain, which may appear suddenly and worsen significantly when pressure is placed on the affected tooth. The tooth may feel out of alignment in some way, and it may be mobile. Depending on the location and significance of the abscess, the periodontal ligament and alveolar bone in the area may be destroyed. The gum tissue that covers the area of abscess is likely to appear red and swollen, and the tissue may be shiny as it stretches over an inflamed area. The adjacent lymph node may also be swollen and tender. Once pus forms in the lesion, pressure increases, leading to increased pain. Eventually, the abscess will spontaneously drain, relieving the pressure and the pain but causing unpleasant or unhealthy side effects. Before it drains, the infection may spread into surrounding tissues and into other bodily systems, causing fever and widespread pain.
Periodontal abscesses usually arise from advanced periodontal disease. When pathogens from the oral cavity find their way into the soft tissues of the gums through periodontal pockets in the gingival sulcus, and they are not effectively held in check by the body’s immune system, this imbalance may cause an inflammatory response. As bacteria multiply in the soft tissues of the gums, the immune system attempts to isolate the infection and prevent it from spreading, forming an abscess. When the periodontal pockets are very deep, as may be the case with severe periodontal disease, plaque, tartar, and food debris may block the periodontal pocket, leading to infection. Any artificial debris trapped in the periodontal pocket may lead to abscess; risks occur with any penetrating injury or trauma to the tissue, as well as during some clinical treatments that can be performed incorrectly or incompletely. Systemic immune deficiency may also make people more prone to periodontal abscesses.
If a root canal is perforated during root canal surgery, this can lead to a periodontal abscess, as the abscess is caused by infection from the procedure and not due directly to the death of the tooth. This is an important distinction, as periodontal abscesses and periapical abscesses are treated and managed differently. The primary consideration when planning treatment is determining whether the involved tooth will be extracted or not. While the tooth itself is still alive when a periodontal abscess is present, a history of periodontal abscesses and severe periodontitis worsen the prognosis for any tooth, and if this prognosis is particularly bad, it may be preferable to remove the tooth. If the abscess has not yet drained, or has only begun draining, the first step in treatment is empty and clean out the pocket, stimulating the soft tissues to begin healing. This step relieves the patient’s pain and also manages the infection. Antibiotics may be prescribed when more severe infection is present. Finally, the factors that contributed to the abscess will be addressed; this is most commonly periodontal scaling and oral hygiene instruction, which is the most commonly used therapy for periodontal disease.