PERIODONTAL ABSCESS

PERIODONTAL ABSCESSHERRINA FIRMANTINITERMA periodontal abscess is a localized purulent inflammation in the periodontal tissuesIt is also known as a lateral abscess or a parietal abscess.

Periodontal abscess formation may occur in the following ways1. Extension of infection from a periodontal pocket deeply into the supporting periodontal tissues and localization of the suppurative inflammatory process along the lateral aspect of the root.2. Lateral extension of inflammation from the inner surface of a periodontal pocket into the connective tissue of the pocket wall. Formation of the abscess results when drainage into the pocket space is impaired.Periodontal abscess formation may occur in the following ways3. Formation in a pocket with a tortuous course around the root. A periodontal abscess may form in the cul-de-sac, the deep end of which is shut off from the surface.Periodontal abscess formation may occur in the following ways4. Incomplete removal of calculus during treatment of a periodontal pocket. The gingival wall shrinks, thereby occluding the pocket orifice, and a periodontal abscess occurs in the sealed-off portion of the pocket.Periodontal abscess formation may occur in the following ways5. After trauma to the tooth or with perforation of the lateral wall of the root in endodontic therapy. In these situations, a periodontal abscess may occur in the absence of periodontal disease.Periodontal abscess formation may occur in the following waysPeriodontal abscesses are classified according to location asfollows:1. Abscess in the supporting periodontal tissues along the lateral aspect of the root. With this condition, a sinus generally occurs in the bone that extends laterally from the abscess to the external surface.2. Abscess in the soft-tissue wall of a deep periodontal pocket.Periodontal abscesses are classified according to location asfollows:

CLINICAL EXAMINATIONPeriodontal abscesses may be acute or chronic.The acute periodontal abscessAppears as an ovoid elevation of the gingiva along the lateral aspect of the root . The gingiva is edematous and red, with a smooth, shiny surface. The shape and consistency of the elevated area vary; the area may be domelike and relatively firm, or it may be pointed and soft. In most cases, exudate may be expressed from the gingival margin with gentle digital pressure.The acute periodontal abscessAccompanied by symptoms such as throbbing, radiating pain, and tenderness of the gingiva to palpation. The acute periodontal abscessOther symptoms may include sensitivity of the tooth to palpation; tooth mobility and lymphadenitis; and, less Frequently, systemic effects such as fever, leukocytosis, and malaise.

The acute periodontal abscessOccasionally the patient may have symptoms of an acute periodontal abscess without any notable clinical lesion or radiographic changesThe acute periodontal abscess

The chronic periodontal abscessusually presents a sinus that opens onto the gingival mucosa along the length of the root. There may be a history of intermittent exudation. The orifice of the sinus may appear as a difficult-to-detect pinpoint opening, which, when probed, reveals a sinus tract that leads deep into the periodontium.

The chronic periodontal abscessThe sinus may be covered by a small, pink, beadlike mass of granulation tissue. The chronic periodontal abscess is usually asymptomatic.

The chronic periodontal abscess However, the patient may report episodes of dull, gnawing pain; a slight elevation of the tooth; and a desire to bite down and grind the tooth. The chronic periodontal abscess often undergoes acute exacerbations, with all of the associated symptoms.

The chronic periodontal abscessDiagnosis of the periodontal abscess requires the correlation of the history with the clinical and radiographic findings. The suspected area should be probed carefully along the gingival margin in relation to each tooth surface to detect a channel from the marginal area to the deeper periodontal tissues.

Continuity of the lesion with the gingival margin is clinical evidence that the abscess is periodontal.

Periodontal Abscess and Gingival AbscessThe principal differences between the periodontal abscess and the gingival abscess are location and history. The gingival abscess is confined to the marginal gingiva, and it often occurs in previously disease-free areas. It is usually an acute inflammatory response to the forcing of foreign material into the gingiva. The periodontal abscess involves the supporting periodontal structures, and it generally occurs during the course of chronic destructive periodontitis.

Periodontal Abscess and Gingival AbscessPeriodontal Abscess and Periapical AbscessSeveral characteristics can be used as guidelines when differentiating a periodontal abscess from a periapical abscess. If the tooth is nonvital, the lesion is most likely periapical. However, a previously nonvital tooth can have a deep periodontal pocket that can abscess.

Periodontal Abscess and Periapical AbscessMoreover, a deep periodontal pocket can extend to the apex and cause pulpal involvement and necrosis.

Periodontal Abscess and Periapical AbscessLaboratory Aids to Clinical DiagnosisWhen unusual gingival or periodontal problems are detected that cannot be explained by local causes, the possibility of contributing systemic factors must be explored. The signs and symptoms of oral manifestations of systemic disease have to be clearly understood and analyzed and their presence discussed with the patients physician.Analyses of blood smears, blood cell counts, white blood cell differential counts, and erythrocyte sedimentation rates are used to evaluate the presence of blood dyscrasias and generalized infections.Determinations of coagulation time, bleeding time, clot retraction time, prothrombin time, and capillary fragility as well as bone marrow studies may be required at times.THANK YOU