Periodontal abscess
Adapted from Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Abscesses_of_the_periodontium
A gingival abscess between the lower left canine and first
premolar.
A Periodontal abscess (also termed lateral abscess, or parietal abscess), is a localized
collection of pus (i.e. an abscess) within the tissues of the periodontium. It is a type of dental
abscess. A periodontal abscess occurs alongside a tooth, and is different from the more common
periapical abscess, which represents the spread of infection from a dead tooth (i.e. which has
undergone pulpal necrosis). To reflect this, sometimes the term "lateral (periodontal) abscess" is
used. In contrast to a periapical abscess, periodontal abscesses are usually associated with a vital
(living) tooth. Abscesses of the periodontium are acute bacterial infections classified primarily by
location.
Classification
Match the type of abscess with the right definition:
There are four types of abscesses that can involve the periodontal tissues:
Gingival abscess
a localized, purulent infection involving a
greater dimension of the gum tissue, extending
apically and adjacent to a periodontal pocket.
Periodontal abscess
a localized, purulent infection within the gum
tissue surrounding the crown of a partially or
fully erupted tooth. Usually associated with an
acute episode of pericoronitis around a partially
erupted and impacted mandibular third molar
(lower wisdom tooth).
a localized, purulent infection involves only the
soft gum tissue near the marginal gingiva or the
interdental papilla
Pericoronal abscess
Causes
Fill in with one of the words under the text:
A periodontal abscess most commonly occurs as a complication of advanced periodontal disease
(which is normally painless). A periodontal pocket contains dental plaque, bacteria and
subgingival calculus. Periodontal ……….. continually find their way into the soft tissues, but
normally they are held in check by the ………. A periodontal abscess represents a change in this
balance, related to decreased local or systemic resistance of the ……………. An inflammatory
response occurs when ………… invade and multiply within the soft tissue of the gingival
crevice/periodontal pocket. A pus-filled abscess forms when the ………………responds and
attempts to isolate the infection from spreading.
Communication with the oral environment is maintained via the opening of the periodontal
pocket. However, if the opening of a periodontal pocket becomes obstructed, as may occur if the
pocket has become very deep (e.g. with furcation involvement), then plaque and calculus are
trapped inside. Food packing may also obstruct a periodontal pocket. Food packing is usually
caused by failure to accurately reproduce the …………points when dental restorations are placed
on the interproximal surfaces of teeth. Another potential cause occurs when a periodontal pocket
is ………. incompletely. Following this procedure, the gingival …….. tightens around the tooth,
which may be enough to trap the bacteria left in the pocket. A gingival retraction cord which is
accidentally left …………is an occasional cause of a periodontal abscess.
cuff
pathogens
bacteria
scaled
immune system(2x)
in situ
contact
host
Fill in with the correct form of the word on the right:
……..(1) injury to the gingiva e.g. with a toothbrush bristle,
fishbone, toothpick or periodontal instrument may inoculate
bacteria into the tissues. Trauma to the tissues, e.g. …….(2) by
an impact on a tooth, or ……….(3) pressure exerted on teeth
during orthodontic treatment. ……(4) overload may also be
involved in the development of a periodontal abscess, but this is
rare and usually in combination with other factors. Bruxism is a
common cause of excessive occlusal forces. Systemic immune
factors such as diabetes can ……..(5) to the formation of
periodontal abscesses.
(1) penetrate
(2) cause
(3) exceed
(4) occlude
(5) predisposition
Signs and symptoms
The main symptom is pain, which often suddenly appears, is 1. destroy
made worse by biting on the involved tooth, which may feel 2. throb
raised and prominent in the bite. The tooth may be mobile, and 3. swell
the lesion may contribute to ………..(1) of the periodontal
4. pain
ligament and alveolar bone.[4] The pain is deep and …….. (2).
The oral mucosa covering an early periodontal abscess appears 5. stretch
erythematous (red), ………(3) and ………(4) to touch.[3] The 6. fluctuate
surface may be shiny due to …………(5) of the mucosa over 7. charge
the abscess. Before pus has formed, the lesion will not be 8. region
…………(6), and there will be no purulent ………..(7). There 9. drain
may be ……….(8) lymphadenitis. When pus forms, the 10. anatomy
pressure increases, with increasing pain, until it spontaneously
drains relieving the pain. When pus drains into the mouth, a bad
taste is perceived. Usually ……….(9) occurs via the
periodontal pocket, or else the infection may spread as a
cellulitis or a purulent odontogenic infection. Local
……….(10) factors determine the direction of spread. There
may be systemic upset, with malaise and pyrexia.
Comprehension check:
1. What is the difference between periodontal abscess and periapical abscess?
2. How many types of abscesses involve the periodontal tissue?
3. Mention several causes of periodontal abscess.
4. What type of pain is a symptom of periodontal abscesses and how is it relieved?