An abscess is a localized acute accumulation of living or dead cells (Polymorphonuclear neutrophils) which liberates various enzymes. These enzymes will cause digestion of other tissue structures and cells and form a liquid product which is known as pus. Patient will have gingival or periodontal abscess if pus is formed in the gums. Gum abscess is one of common dental emergencies. When the gum abscess is limited to gums (Marginal gingiva and or interdental papillae), then it is known as gingival abscess and when deeper supporting structures of the gums are affected, then it is known as periodontal abscess. Periodontal abscess involves gum, periodontal membranes and bone. Periodontal abscess is usually associated with deep pockets, furcation and bone defects. Immediate treatment is required for gum abscess. Gingival and periodontal abscess causes acute inflammatory enlargement of gums.
Gingival gum abscess causes acute inflammatory enlargement. It is a localized, painful, rapidly expanding lesion and is sudden in onset.
Impaction of foreign objects such as tooth brush bristles or fragments of food substances (piece of apple core or lobster shell fragment) in previously healthy sites can lead to gingival gum abscess.
1. The gums appear red, swollen and extremely painful and at times, the impacted foreign object may still be embedded in the gums.
2. Red swelling appears with smooth shiny surface which is painful.
3. Associated teeth are sensitive to percussion in early stages of gingival gum abscess.
4. It is a rapidly expanding lesion and only the gums are affected in this (Marginal gingiva and interdental gingiva) and not the supporting structures.
5. The lesion becomes fluctuant and pointed with an opening from which pus may come out. The lesion ruptures spontaneously if pus comes out.
No bone loss is present in case of gingival gum abscess.
1. If the cause of abscess is still present, then it should be removed.
2. Drainage can be established by warm saline rinses used every 2 hours.
3. Curettage under local anesthesia or incision may be given if the bump due to gum abscess persists.
4. Systemic antibiotic is prescribed to the patient if the lesion is persistent and severe.
5. Sub gingival curettage or localized gingivectomy may also be required to remove any residual pocketing.
Inflammation spreads from the gums to the supporting tissues around the gums (Periodontium) which will result in periodontal pocket formation. Opening of periodontal pocket is closed by soft tissue and periodontal pocket becomes closed sac. Bacterial multiplication occurs in periodontal pocket which cause periodontal gum abscess formation within the pocket. Periodontal gum abscess formation may also cause swelling and destruction of bone and gum boil or parulis formation may also occur by ballooning of overlying soft tissue. Fistula may also be formed by periodontal abscess.
Periodontal Abscess Originating from a Maxillary Central Incisor
The main cause of periodontal gum abscess is periodontal pocket related to destruction by periodontitis. Periodontitis mostly occurs because of food accumulates present around the teeth and tooth malpositioning, faulty restoration present or due to smoking and genetic influence. Periodontal Infection is usually due to long standing irritation by food accumulates or deep deposits. Periodontal gum infection may also occur because of gross decay of the tooth (Endo-Perio Lesion). Abscess if present in the tooth can move out from the tooth and may infect the bone and surrounding tissues. Perforation during root canal treatment can also lead to periodontal infections due to spreading of bacteria. Incidence of periodontal gum abscess is more in case of diabetic patients.
1. Periodontal gum abscess is commonly associated with periodontal pocket which can either be infrabony periodontal pocket or can be suprabony periodontal pocket.
2. Tooth elevation and mobility may also be seen in case of periodontal gum abscess.
3. In case of periodontal gum abscess, tooth is tender on lateral percussion.
4. Pain in case of periodontal gum abscess is localized and patient can identify the offending tooth. Patient will feel pain and tenderness in the gums on chewing.
5. Affected tooth may be vital or sometimes it is non-vital.
6. Tooth with periodontal abscess may also be associated with fistula.
7. Gums are inflamed, tender and swollen and will appear red and shiny
8. Damage to the bone also occurs in case of periodontal gum abscess.
9. From the gums of the tooth, pus drainage is there.
10. Patient will have bad breath and bad taste in mouth in case of periodontal gum abscess.
11. There is increased body temperature present. Along with that, lymph nodes are also swollen.
X-Ray Findings in Case of Periodontal Gum Abscess
Bone loss is seen in case of periodontal gum abscess. Radiolucency that is a shadow is visible along the lateral aspect of root of the tooth.
If there is periodontal pocket associated with the tooth and along with that, bone loss is present, then it is suspected to be periodontal abscess and in cases where large cavity is present and there is sensitivity to hot and cold food stuffs is present, then dental abscess due to pulpal origin is suspected. Pulpal abscess is present at the apex of the tooth and periodontal gum abscess is present in the lateral position of tooth. If patient feels shock feeling on placing electric current, then it can be because of periodontal gum abscess.
In case of tooth with periodontal abscess, prognosis of tooth is seen. If the prognosis of tooth is very poor, then tooth extraction may also be required. To avoid spread of infection and for some pain relief, drainage of abscess is done. If the abscess is discharging on its own, then local, topical, regional anesthesia is given to the patient depending on the size of abscess and pus is removed by inserting dental probe in the pocket. To remove the pus and all the granulation tissue, dental probe or dental curette can be used by the dentist. Incision is given on the most fluctuant part of abscess in case the abscess is not discharging freely. After incision, tissues are elevated to establish drainage and after that, area is irrigated with saline solution. To promote healing and to reduce inflammation of tissues, patient is advised to do warm saline rinses (1 table spoon of salt to 1 glass of warm water). To reduce infection, antibiotics may also be given. (Amoxycillin, Metronidazole, Clindamycin in case patient is allergic to Penincilin)
If the patient can’t take dental help due to financial problems or some other problem, then he can do warm saline rinses and can use clove or clove oil for some temporary relief. Ibuprofen, motrin, acetaminophen pain meds can be used by patient. Mouth washes and peroxide flushes will also provide some relief to the patient. Antibiotics can also be taken for temporary relief of periodontal abscess. Some of these natural remedies for gum diseases will provide some relief. These modalities can be used for temporary pain relief only. To treat the infection, patient has to visit his dentist.
To prevent gum diseases and gum infection, patient should maintain good oral hygiene by brushing and flossing regularly. There should be no food deposits present around the teeth which can lead to gum infections and gum abscess. Patient should get dental cleaning done regularly to avoid periodontal pockets which can further lead to periodontal gum abscess.
Scaling and root planning which is required by the patient in case of periodontal gum surgery will cost him around $150-$250 per quadrant without dental insurance. Periodontal gum surgery if done can cost around $450-$850 depending on the type of gum surgery which is done. Treatment for periodontal gum abscess is mostly covered by dental insurance at 70-80%
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