Something that most patient remember about dental pain is referred to tooth pain and tissue swelling. Sometimes this problem refers to the loss of vitality of a tooth but it can also be referred to periodontal problems. We will analyze the second scenario and we will compare it with the classical tooth that needs a root canal therapy by the endodontist.

The periodontal abscess is a localized purulent inflammation of the periodontal tissues. It can be classified according to the structure that it affects in gingival, periodontal and pericoronal abscess. The gingival abscess affects the marginal gingival and interdental tissues. The periodontal abscess is an infection located in the periodontal pocket and may result in destruction of the periodontal ligament and bone. The pericoronal abscess refers to the area next to a tooth crown that is not fully erupted in the mouth.

Periodontal Abscess
The periodontal abscess is typically found in patients with active periodontitis and in association with moderate-to-deep periodontal pockets. Periodontal abscesses often arise as an acute episode of a preexisting periodontal disease. Among the difference causes, the most common is the incomplete calculus removal from a gingival pocket. Abscesses can occur after periodontal surgery, after preventive maintenance, after systemic antibiotic therapy and recurrence of periodontal disease. Other causes of periodontal abscesses can be tooth perforation or fracture and foreign body impaction. The importance of periodontal abscesses is high. Their presence is a leading cause of tooth loss. However, proper treatment and constant follow up can help to retain affected teeth for many years.

Acute versus Chronic Abscess
Abscesses are categorized as acute or chronic. The acute abscess is often a sudden episode of an existing periodontal lesion with no liquid drainage through the gums. The result is a painful, red, smooth swelling of the gingival tissues. The tooth may be percussion sensitive and feel elevated in the socket. The chronic abscess form after the infection spontaneously drains or it’s treated by the periodontist.

Periodontal versus Pulpal Abscess
The following table summarizes the main differences between Periodontal and pulpal abscesses. Sometimes symptoms are mixed and do not help with correct diagnosis and an interdisciplinary consultation with the endodontist may be necessary

Treatment of the periodontal abscess includes the resolution of the acute lesion, followed by the management of the resulting chronic condition. Treatment options include drainage through pocket retraction or incision, scaling and root planning, periodontal surgery, systemic antibiotics or tooth removal*. The treatment of pulpal abscess is usually the completion of a root canal therapy by the endodontist that in severe case may have to associate this pathology with systemic antibiotics and drainage of the swelling for acute abscesses.

Acute abscesses can be a very bad experience for the patient. Due to complexity of appearance, it may be difficult to differentiate between endodontic and periodontal abscesses, It is important to urgently contact the periodontist that is trained to tackle and treat this pathology and improve the fate of the affected tooth.

References

*(Modified from Sanz M, Herrera D, van Winkelhoff AJ: The periodontal abscess. In Lindhe, J: Clinical periodontology, Copenhagen, 2000, Munksgaard).

The body of this article is referred to Carranza’s Clinical Periodontology, 12th Edition By Michael G. Newman, DDS, Henry Takei, DDS, MS, Perry R. Klokkevold, DDS, MS and Fermin A. Carranza, Dr. ODONT.

– Lorenzo Mordini DDS, MS

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