Periodontology Diagnosis - Abscesses of the Periodontium

A periodontal abscess is a collection of pus in the periodontium tissues. It is also considered a type of dental abscess. A periodontal abscess occurs adjacent to a tooth, and is different from a periapical abscess, which occurs when inspection spreads from a dead tooth. The term "lateral or periodontal abscess" is sometimes used to describe the condition. Contrary to a periapical abscess, a periodontal abscess is usually associated with a living tooth. Abscesses of the periodontium are considered acute bacterial infections which are primarily classified by location.

Signs and symptoms

The main symptom of the condition is pain. The pain often appears suddenly, and worsens when biting down on the tooth. The tooth itself may feel raised and overly prominent in the bite. The tooth may also move, and the lesion can contribute to the destruction of the periodontal ligament in addition to the alveolar bone. The pain that patients typically experience is deep and throbbing. The oral mucosa covering an early periodontal abscess is usually red, swollen and painful to the touch. The surface may also be shiny from the stretching of the mucosa over the abscess. Prior to the formation of pus, the lesion will not be fluctuant, and there will not be discharge.

When pus does form, the pressure also increases. The increasing pressure causes pain until it eventually drains which relieves the pain. When the pus drains into the mouth, it can result in a bad taste and odor.

Causes

A periodontal abscess most often occurs as the result of a complication from advanced periodontal disease. Periodontal disease, however, is typically painless. A periodontal pocket will contain dental plaque, bacteria and subgingival calculus. Periodontal pathogens find their way into the soft tissues, however, they are normally contained by the immune system. A periodontal abscess demonstrates a change in this balance, as there is a decreased local or systemic resistance of the host. An inflammatory response occurs when bacteria invades and multiplies within the soft tissue of the gingival crevice or periodontal pocket. A pus-filled abscess forms as the result of the immune system responding and attempting to isolate the infection from spreading.

Communication with the oral environment is established through the opening of the periodontal pocket. When the opening of a periodontal pocket becomes obstructed, however, plaque and calculus can become trapped inside. Another potential cause can occur when a periodontal pocket is incompletely scaled. Following the procedure, the gingival cuff will tighten around the tooth, which can the bacteria which remains in the pocket.

The penetrating injury to the gingiva, such as with a toothbrush bristle, small bone, toothpick or periodontal instrument, can also allow bacteria into the tissues. Trauma to the tissues, such as with serious tooth impact or excessive pressure which can occur during orthodontic treatment, can also be a possible cause. Occlusal overload can also be to blame for the development of a periodontal abscess, however, this is rare and usually occurs in addition to other factors.

Systemic immune factors like diabetes can put a person at risk for the formation of periodontal abscesses. Perforation of a root canal which occurs during endodontic therapy can also result in a periodontal abscess.

Diagnosis

Periodontal abscesses can be challenging to distinguish from a periapical abscesses. Because the management of a periodontal abscess differs from a periapical abscess, this differentiation is critical. As an example, root canal therapy is not necessary and does not have any impact on pain in a periodontal abscess.