Chronic Periodontal Abscess: Causes, Symptoms, And Treatment Options

Describe etiology, clinical features and management of chronic periodontal abscess.
Answer.

Chronic Periodontal Abscess Etiology

It occurs when the coronal portion of the pocket becomes occluded.
When widening of periodontal abscess occurs for a long time.
When acute periodontal abscess exacerbates, it converts into the chronic periodontal abscess.

Chronic Periodontal Abscess Clinical Features

It presents a sinus that opens onto the gingival mucosa somewhere along the length of root.
Intermediate exudation present for a long time.
Orifice of sinus may appear as difficult to detect pinpoint opening, which reveals a sinus tract, deep in the periodontium, when probed.
Sinus may be covered by a small, pink bead-like mass of granulation tissue.
Patient may report episodes of dull, gnawing pain, slight elevation of tooth and a desire to bite down on and grind the tooth.
Chronic periodontal abscess often undergoes acute exacerbations, with all associated symptoms.

Chronic Periodontal Abscess Management

Scale all the deposits from the teeth and root surfaces are planed with scaler and is smoothened with curettes.
Systemic antibiotics, i.e. amoxicillin and metronidazole are given.
Locate the abscess area, probing is done around the gingival margin, following tortuous pockets to termination. If sinus is present, abscess may be probed through it.

Treatment by Flap Operation

Area is anesthetized by local infiltration.
Two vertical incisions are given at gingival margin at mucobuccal fold, outlining field of operation. If lingual approach incision is used, incision is made from gingival margin to level of root apices. As vertical incisions are given a mesiodistal incision is given across interdental papilla with knife to facilitate detachment of flap.
A full thickness flap is raised by periosteal elevator and is held in position by retractor.
Granulation tissue is removed with curette to provide clear view of root. If sinus is present, it is explored and curetted.
Facial and lingual surfaces are covered by U-shaped gauze which is held in position till bleeding stops.
Gauze is removed, flap is sutured and covered by periodontal pack.

Sorrin’s Operation

This procedure is suitable when marginal gingiva is healthy and there is no access to abscess area. In this, a semilunar incision is given underneath involved area in attached area and leaving gingival margin undisturbed. A flap is raised to enter in abscessed area for curettage.

difference between periodontal abscess and lateral periodontal cyst

Periodontal Abscess And Cyst Comparison

Significance of Formation of Periodontal Abscess

There is extension of infection from periodontal pocket deeply into supporting periodontal tissues and localization of suppurative inflammatory process along the lateral aspect of root.
There is lateral extension of inflammation from the inner surface of periodontal pocket into the connective tissue of pocket wall. Localization of abscess results when drainage in the pocket space is impaired.
Formation of periodontal abscess in the pocket with tortuous course around the root. It forms in the deep end which is shut off from the surface.
Incomplete removal of the calculus during treatment of periodontal pocket leads to shrinkage of gingival wall, occluding the pocket orifice and a periodontal abscess occur in the sealed portion of pocket.