Periodontal Abscess
Question 1. Describe sign and symptoms of acute periodontal abscess. How will you differentiate between acute periodontal abscess and acute periapical abscess.
Or
Write short note on treatment of acute periodontal abscess.
Or
What is periodontal abscess? Give clinical features and treatment of acute periodontal abscess.
Or
Write differences between periodontal abscess and periapical abscess.
Answer. Periodontal abscess is defined as a suppurative lesion associated with periodontal breakdown and localized accumulation of pus within a gingival wall of periodontal pocket.
Acute Periodontal Abscess Clinical Features
Signs of Acute Periodontal Abscess
- It appears as an ovoid elevation of gingiva along the lateral aspect of root.
- Gingiva is edematous and red, with smooth shiny surface.
- Area may be dome like and relatively firm or pointed and soft.
- In most cases, pus is expressed from the gingival margin with gentle digital pressure.
- Sensitivity is present to percussion of offending tooth.
- Bleeding on probing is present.
- Pinpoint orifice of sinus may be present. Sinus is usually enclosed with small, pink, bead-like mass of granulation tissue.
Read And Learn More: Periodontics Question And Answers
Symptoms of Acute Periodontal Abscess
- There is an acute episode usually has sudden onset with extreme onset.
- Tooth elevation and mobility is seen.
- Pain is localized and patient can identify the offending teeth.
- Pain is throbbing and radiating in nature.
- Fever, leukocytosis and malaise are present.
Acute Periodontal Abscess Treatment
- As the condition is a dental emergency. Patient should be treated as soon as possible to relieve pain and resolve the infection.
- Various treatment modalities are:
- Drainage through pocket retraction or incision.
- Scaling and root planning
- Periodontal surgery
- Systemic antibiotics
- Extraction of tooth
- Treatment should be carried out in two stages, i.e. management of acute lesion and proper treatment of residual lesion as acute condition come under control.
- Primary treatment for relief of acute symptoms is incision and drainage.
Procedure for Incision and Drainage
- Anesthetize the area and a probe is carefully introduced in pocket in an attempt to distend the pocket wall.
- Now a small curette then gently used to penetrate tissues and establish the drainage. Root surface is then thoroughly planed to eliminate plaque and calculus.
- When drainage is not easily established or when abscess is seen pointing via the gingiva an external incision is given.
- Take a no.11 Bard–Parker blade, a vertical incision is given at the highest point of fluctuation.
- As initial extravasation of blood and pus is over, area is irrigated by antiseptic agent and incision is gently spread to facilitate the drainage.
- As procedure gets completed, patient is instructed to rinse with warm saline and is examined after 24 to 48 hours.
- Systemic antibiotics, i.e. amoxicillin and metronidazole are given to the patient.
- Another treatment for new attachment and new tissue regeneration may be performed.
- If roots are denuded beyond the apical third of root, tooth is extracted and curettage is done to remove granulation tissue from pocket.
Difference between Acute Periodontal Abscess and Acute Periapical Abscess
Question 2. Describe etiology, clinical features and management of chronic periodontal abscess.
Answer.
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.
Question 3. Give difference between periodontal abscess and lateral periodontal cyst.
Answer.
Question 4. Write short note on periodontal abscess.
Or
Write short note on periodontal abscess and its management.
Answer.
Periodontal Abscess
Periodontal abscess is defined as a suppurative lesion associated with periodontal breakdown and localized accumulation of pus within the gingival wall of a periodontal pocket.
Periodontal Abscess Diagnosis
- Diagnosis of periodontal abscess is established by understanding patient’s chief complaint, overall clinical evaluation and assessment of clinical and radiographic findings.
- Probe the suspected area carefully along the gingival margin in association with each tooth surface which helps in identifying tract from marginal area to deep periodontal tissues.
- Clinically ovoid swelling of gingiva, pain and tooth mobility, tooth elevation, suppuration, either spontaneous or on digital pressure and in presence of deep periodontal pockets are seen.
- Radiographically periodontal bone is either normal or is associated with some bone loss.
- Lesion in the soft tissue wall is least likely to produce the radiographic changes than those deep in the supporting tissues. Similarly, abscess over facial and lingual surfaces are obscured by radiopacity of root.
- A radiograph taken with gutta-percha point inserted gently into the suspected pocket can help to define origin of abscess.
Periodontal Abscess Complications
- Tooth loss: Periodontal abscesses are identified as causative agent for tooth extraction in process of supportive periodontal therapy.
- Dissemination of infection: Cellulitis, subcutaneous infection, phlegmon and mediastinitis can occur from odontogenic infections and are uncommon with periodontal abscess. Mechanical management of periodontal abscess lead to bacteremia in patients with immunocompromised states can result in non-oral infections.
Question 5. Write short note on periodontal abscess and its significance of the formation.
Answer.
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.
Question 6. Write short note on gingival abscess.
Answer. Gingival abscess is a localized, acute inflammatory lesion that may arise from many sources including microbial plaque infection, trauma and foreign body impaction.
Etiology
Due to impaction of foreign objects in previously healthy sites.
Gingival Abscess Clinical Features
- It is a painful, rapidly expanding lesion usually of sudden onset.
- It is limited to marginal gingiva or interdental papilla.
- In early stages, it appears as red swelling with a smooth shiny surface.
- Within 24–48 hours the lesion become fluctuant and pointed with a surface orifice from which purulent exudate may be expressed.
- Adjacent teeth are sensitive to percussion.
Gingival Abscess Treatment
- Treatment is aimed at reversal of acute phase and when applicable immediate removal of cause.
- For procedural comfort topical or local anesthesia is administrated.
- Scaling and root planning is done to establish drainage.
- In more acute situations no. 15 blade is used to incise the fluctuant area and exudate is expressed by gentle pressure.
- Area is irrigated with warm water and covered with moist gauze under light pressure.
- As bleeding is stopped patient is dismissed with instructions to rinse with warm salt water every 2 hours for remainder of the day.
- After 24 hours area is reassessed.
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