22. Periodontal abcesses Flashcards
Periodontal abscess definition
Localised purulent inflammation of periodontal tissues
Types of abscess
- Gingival abscess=>marginal gingiva and interdental tissues
- Periodontal abscess=>infection localised to periodontal pocket=>
- Destruction of PDL and alveolar bone
- Pericoronal abscess=>associated w/ crown of partially erupted tooth
- Periapical abscess=>Forms at root tip
- Acute
- Chronic
Clinical presentation of gingival abscess
- Localised acute inflammatory lesion
- Red, smooth and sometimes painful swelling
- Aetiology-Plaque, trauma, foreign body impaction
Involves marginal and interdental gingiva
Clinical presentation of Periodontal abscess
- In patients w/ untreated periodontitis
- Major cause of tooth loss
- Can occur=>after periodontal surgery, recurrent disease, tooth perforation, foreign body impaction
- Diabetes predisposing factor
Clinical presentation of Pericoronal abscess
- Inflammation of soft tissue operculum covering partially erupted tooth
- Commonly mandibular 3rd molars
- Aetiology=>plaque, food impaction, trauma
Periodontal abscesses
Acute abscess
- Exacerbation of chronic inflammatory periodontal lesion=>
- Increased no. and virulence of bacteria
- Lowered tissue resistance and lack of spontaneous drainage
- Painful red, edematous swelling of gingival tissues
- Exudate expressed w/ gentle press
- Tooth sensitive to percussion and feel elevated in socket
Drainage may be affected by deep pocket morphology, debris
Periodontal abscess
Chronic abscess
- Spreading infection=>controlled by spontaneous drainage, host response or therapy
- Hemostasis exists between host and infection
- Little to no symptoms
- May be dull pain, inflammation and fistulous tract
- Tooth may be slightly elevated
Usually no systemic involvement
Reasons for antibiotic therapy in patient w/acute abscess
- Cellulitis
- Deep inaccessible pocket
- Fever
- Regional lymphadenopathy
- Immunocompromised patient
Antibiotic options for periodontal infections
- Amoxicillin=>500mg-1g(loading dose) then 500mg x3/day for 3 days->re-evaluation after 3 days
- Penicillin allergy=> clindamycin-600mg loading dose then 300mg x4/day for 3 days
- Azithromycin-1g loading dose then 500mg x4/day for 3 days
Re-evaluation to dettermine need for continued use
Types of drainage of abscesses
- Drainage through periodontal pocket
- Drainage through external incision
Drainage through periodontal pocket
- La around abscess
- Pocket access w/ probe or currette to initiate drainage
- Digital pressure and irrigation to express exudate
- Use of antibiotics
Debridement, scaling, root planning, surgical access avoided until major clinical signs resolved
Drainage through external incision
- Abscess dried and isolated w/ gauze sponges
- La applied
- Vertical incision w/ no.15 through center of abscess
- Exudate expressed and wound edges approximated under light digital pressure
- Antibiotics given
Treatment for patients who need systemic antibiotics
- Rinse w/ salt water and use of CHX
- Reduced exertion
- Increased fluid intake
- Analgesics if pain
