Periodontology Diagnosis - Abscesses of the Periodontium

A periodontal abscess, is an area where pus has collected within the periodontium tissues. A periodontal abscess occurs next to a tooth and differs from a periapical abscess which is quite common. A periapical abscess occurs when the infection from a dead tooth spreads. As a result, the term lateral abscess is sometimes used. Compared to a periapical abscess, periodontal abscesses are typically alongside a living tooth. Abscesses of the periodontium are considered acute bacterial infections which are primarily classified based on their location.

Signs and Symptoms

The main symptom of a periodontal abscess is pain. The pain is often brought on suddenly, and worsens when the patients bites down using the effected tooth. The tooth may also feel slightly raised or more prominent. It is possible for the tooth to move, and the lesion can also cause destruction to the periodontal ligament and alveolar bone. The pain which most patients experience is deep and throbbing. The oral mucosa which covers the periodontal abscess in the early stages, is red, swollen and painful to the touch. Because of the stretching of the mucosa over the abscess, the surface may have a shiny appearance.

Once the pus forms, the pressure grows and becomes more uncomfortable until the abscess spontaneously drains which will relieve the discomfort. There is often a bad taste and odor in the mouth when the pus drains. In most cases, the drainage occurs within the periodontal pocket. The local anatomic factors will determine how the pus spreads. There may also be a systemic upset, which includes an onset of a fever and pain.

Causes

A periodontal abscess typically occurs as a result of complication from advanced periodontal disease, which does not normally cause pain. Periodontal pockets usually contain bacteria, dental plaque, and subgingival calculus. It is normal for the periodontal pathogens to make their way into the soft tissues, however, the immune system usually fights off the development of an infection. Periodontal abscesses indicate that there is a change in the normal balance. There is an inflammatory response when bacteria invade and multiply within the soft tissue of the periodontal pocket. An abscess which is filled with pus forms when the immune system reacts and works to prevent the spread of infection.

The opening of the periodontal pocket allows for communication with the oral environment. However, when the periodontal pocket opening is obstructed, which occurs when the pockets become deep, plaque and calculus easily get trapped inside. Food packing, which is usually caused by the failure to restore contact points with dental restorations, can also obstruct the periodontal pocket. Incomplete scaling of the periodontal pocket can also cause an abscess. After the scaling procedure, the gingival cuff tightly closes around the tooth, which can trap any bacteria which remains in the pocket.

A penetrating injury to the gingiva, such as a toothbrush bristle, fish bone, toothpick or another object, can allow bacteria into the tissues. Other possible causes can include trauma to the tissues from serious impact on a tooth or excessive pressure with an orthodontic treatment.

Systemic immune problems, which includes diabetes, can be a predisposition for the formation of a periodontal abscess.

The perforation during a root canal can also result in a periodontal abscess.

It can be challenging to differentiate a periodontal abscesses from a periapical abscesses. Because the treatment of a periodontal abscess differs from a periapical abscess, it is critical to make the correct diagnosis.