Abscesses of the Periodontium
An abscess is a collection or pocket of pus that is concentrated in one location. A periodontal abscess is an abscess that is located within the periodontium. Periodontal abscesses differ from other types of dental abscesses in a few ways. The more common dental abscess known as a periapical abscess occurs when infection spreads from a tooth that has died, while periodontal abscesses occur laterally to a tooth that is still living. These abscesses are classified as acute bacterial infections that are defined primarily by their location. They are characterized by pain that is usually deep and throbbing and that often appears suddenly and worsens when pressure is applied to the affected tooth while biting. The affected tooth may also feel particularly prominent and may be somewhat mobile. The abscess lesion may have a destructive effect on the alveolar bone and the periodontal ligament, and the gum tissue that covers the abscess may appear red, shiny, and swollen and may be painful when touched. The lymph node adjacent to the abscess may also be swollen.
As pus continues to form in a periodontal abscess, the feeling of pressure increases, along with an increase in pain. Eventually, the pus will spontaneously drain; while this will relieve the pain, the pus that drains into the mouth will cause a putrid odor and taste. If the abscess does not drain from the nearby periodontal pocket, infection may spread into the surrounding tissue and possibly the surrounding teeth, and this infection may cause a fever.
The most common cause of periodontal abscess is advanced periodontal disease. Periodontal pockets contain dental plaque and tartar that are rife with bacteria. It is not uncommon for bacteria to leech into the soft tissues of the mouth, but, in a healthy subject, the immune system neutralizes the possible detrimental effects of this bacteria. When the immune system is compromised, which can happen systemically or locally for a variety of reasons, an inflammatory response is triggered and an abscess is formed; the abscess is the immune system’s attempt to contain the infection and prevent it from further spread.
When periodontal pockets are excessively deep, it is easier for excessive plaque and tartar to become trapped within them. Food debris may also lead to obstruction in the periodontal pocket, and inadequate dental scaling can also lead to an accumulation of debris inside the pocket. Periodontal abscess is sometimes also caused by dental materials that are not fully cleared from the periodontal pocket during cleaning or examination, or by an injury to the gum tissue. For example, if anything sharp or pointy, like a toothpick or the bristle of a toothbrush, sufficiently irritates damaged gingival tissue, this can introduce bacteria into the periodontal tissue. Traumatic impact to the gingival tissue, or perforation of a root canal during root canal treatment, can also lead to periodontal abscess.
Treatment for periodontal abscess differs from treatment for periapical abscess, so definitive diagnosis is important. Treatment involves pain management and control of the infection, and treatment methods vary depending on the cause of the abscess, the extent of damage present in the periodontium, and the prognosis for the adjacent tooth or teeth.