A periodontal abscess refers to the localized accumulation of pus as a result of a bacterial infection in the periphery of some tooth. It is also called osteoflegmon and basically consists of a purulent collection in the periapical space, usually secondary to gingivitis or periodontitis.
When a periodontal abscess is formed, the root of the tooth is usually affected and even displaced, and various studies have pointed out the role that diabetes, stress and pregnancy play as predisposing factors for this type of pathology.
They are considered destructive localized infections, since they destroy the periodontal ligament and the alveolar bone and can alter the stability of the tooth, meriting the extraction of the same in some cases.
It is characterized by a pre-existing deep periodontal sac that closed in its upper portion, either spontaneously or as a result of partial treatment, and bacteria and polymorphonuclear debris remain in its root or “bottom” of the sac.
Every gingival abscess is a periodontal abscess confined to the gingival margin; however, not every periodontal abscess is a gingival abscess, as it is a deeper infection that is not confined to the gingival margin.
An untreated periodontal abscess can become complicated to the point of causing bacterial endocarditis, colonizing the paranasal sinuses, or producing septicemia.
Initially, there is redness and acute inflammation in the lateral regions of the affected tooth roots, a common gingivitis process that can be secondary to various causes.
The enlargement of the inflamed area and the onset of sharp, latent stabbing pain begin to establish the diagnosis of abscess.
The pain appears abruptly according to the perception of the patient. The discomfort is limited to the affected tooth, the pain is continuous and without mitigating. The adult patient comes to the emergency room with severe pain that does not allow him to sleep or eat.
The elevation of body temperature is frequent as a physiological response to bacterial infection, it is hard in the acute phase and the tooth is painful on percussion and chewing.
There is an increase in facial volume on the affected side, with pain to the touch in the inflamed area. The patient supports the area with the hand in order to alleviate the pain without result, but creates a sense of security that “avoids” the impact with other objects.
In chronic phase it creates a fistula. Although it is not frequent, this may show hematopurulent secretion. At this stage the pain can be soothed by releasing the internal pressure of the abscess with drainage; However, if treatment is not applied, it can take the neighboring tooth and spread gingivally.
Mobility in the tooth is appreciated due to the inflammation of the gingiva that creates an unstable ground for the root of the tooth, taking away support. Sometimes the root can become invalidating.
If periodontal disease is complicated and allowed to advance over time, the result can be a periodontal abscess.
There are local factors that can justify the formation of an abscess: the use of oral equipment such as respirators, lack of hygiene in splints, poor oral hygiene that leaves food remains on the mucosa for decomposition, drugs, among many other factors.
Gingivitis is the most common form of periodontal disease; it is slow, progressive and mostly painless, so it is often ignored. The patient only becomes aware of the pathology when the pain becomes evident.
Periodontitis, which, like gingivitis, is associated with the accumulation of bacterial plaque, is a complicated form of gingivitis but has not yet produced an abscess.
This inflammation – secondary to tartar, food debris, among other factors – will introduce bacteria into an existing periodontal sac. If the opening of this sac closes or heals, the trapped bacteria will produce pus that will inflame the sac to make it obvious.
The deeper or tortuous the sac, the more likely it is to develop a periodontal abscess.
In order to preserve the vitality of the tooth, periodontal abscess should be considered as a dental emergency, and the contents of the abscess should be drained immediately in order to relieve the tension that the abscess exerts on the adjacent tissues.
Treatment focuses on analgesia and drainage. It has been shown that IM analgesics are not as effective and that, when IM analgesic is combined with the use of swabs with topical analgesic solutions, better analgesia is achieved although not very long-lasting.
Recanalization of the obstructed sac can be attempted with a periodontal probe or an incision made in the abscess.
Although the bibliography suggests the use of systemic antimicrobials only in cases of general condition, in clinical practice the drainage of antibiotics is usually accompanied in order to achieve clinical improvement more quickly and avoid relapses.
The antibiotic treatment of choice consists of the use of amoxicillin with clavulanic acid (875mg / 125mg) every 12 hours for 7 to 10 days.
It is important to highlight that the use of the suicide inhibitor (clavulanic acid) is important for the success of the treatment, so it should not be substituted for amoxicillin (500mg) if it is not indicated by the doctor.
In some very complicated cases, metronidazole can be associated with the use of amoxicillin, in doses of 250mg every 8 hours.
Difference between periodontal abscess and periapical abscess
The difference lies mainly in the location. The periodontal abscess is in the lateral zone of the dental root; In contrast, the periapical abscess is located at the apex of the tooth, that is, from distal to proximal, from the outermost end of the tooth.
The periapical abscess is usually secondary to caries, while the periodontal abscess is usually secondary to diseases in the structures adjacent to the tooth itself.
In the periapical abscess, lack of vitality can be evidenced, in the periodontal abscess it can become devitalized a tooth but only as a complication of the abscess.
The pain of the periapical abscess is generalized, the patient makes it difficult to identify the affected tooth; while in periodontal abscess pain can be localized.
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