Regular dental visits are vital to maintaining good oral health. However, even if you follow the recommended protocol you can still end up with an oral abscess. This article will cover the most common reasons an oral abscess can develop.
There are four general types of abscesses or puss pockets, that develop in the tissues surrounding and supporting the teeth: gingival, periodontal, pulpal, and pericoronal. These are classified based on the origin of the abscess. It is important for a clinician to determine the source of the infection because the treatment approach to eliminate the infection can be different. This article focuses on gingival and periodontal abscesses.
A gingival abscess is a localized, acute inflammatory lesion of the gum that may arise from a variety of sources. These can include bacterial plaque infection, trauma, and foreign body impaction. Clinically a gingival abscess presents itself as a red, smooth, sometimes painful, often fluctuant swelling. In a gingival abscess, the bone supporting the teeth is not affected.
Treatment of a gingival abscess involves eliminating the irritant that is causing the infection. If no clear cause is present the area should be scaled and root planed to remove any microbial irritants that may be present and allow for drainage. After the procedure patient should rinse with salt water, every two hours until the end of the day. Complete healing and resolution is expected within a few days.
A periodontal abscess is a localized, puss forming inflammation of the periodontal tissues (tissues supporting the teeth). A periodontal abscess is most commonly found in individuals with untreated periodontal disease where moderate to deep pocket depth is present. It is also a major cause of tooth loss. Periodontal abscess is usually an acute exacerbation of a periodontal pocket. They have been observed in patients after periodontal surgery, after a preventative periodontal maintenance, systemic antibiotic therapy, as well as due to recurrence of periodontal disease. Poorly controlled diabetes mellitus is considered a predisposing factor in formation of a periodontal abscess. It should be mentioned that a periodontal pocket can also form in the absence of inflammatory periodontal disease. The abscess can be caused by tooth perforation, root fracture or foreign body impaction that is not treated appropriately .
Treatment of a periodontal abscess involves scaling and root planing as well as periodontal surgery when indicated. Periodontal surgery is helpful when there are deep pockets present or if multi-rooted teeth are involved. Surgical procedure allows for exposure of the affected area and direct scaling and root planing of the involved areas. Excess gingival (gum) tissue is also excised, which allows for periodontal pocket reduction after healing is complete. With proper treatment, good oral hygiene and a consistent regimen of periodontal maintenance visits at intervals determined by your dentist, teeth with significant bone loss can be retained for some time. In the next article we will discuss the signs and treatment of pulpal and pericoronal abscess.