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Periodontal abscess
This document provides an overview of periodontal abscesses. It defines a periodontal abscess as a localized collection of pus within the periodontal tissues. Periodontal abscesses are classified based on duration, number, location and etiology. The main causes are periodontitis, trauma from foreign objects, and certain dental procedures. Microbiologically, periodontal abscesses involve anaerobic bacteria normally found in the oral cavity like P. gingivalis, P. intermedia and F. nucleatum. Clinical features include pain, swelling and exudate from the gingiva. Management involves incision and drainage of the acute lesion along with antibiotics and treatment of the underlying condition like scaling or surgery.
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Periodontal abscess
- 1. PERIODONTAL ABSCESS 1 Presented by Dr.Guru Ram Tej K II yr Post Graduate
- 2. CONTENTS INTRODUCTION DEFINITION AND PREVALENCE CLASSIFICATION ETIOLOGYOF PERIODONTAL ABSCESS MICROBIOLOGY PATHOGENESIS AND HISTOPATHOLOGY CLINICAL FEATURES DIAGNOSIS DIFFERENTIAL DIAGNOSIS MANAGEMENT OF PERIODONTAL ABSCESS CONCLUSION REFERENCES 2
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- 4. DEFINITION International conference onresearch in biology of periodontal disease 1977 Carranza 1990 Hafstrom 1994 4
- 5. PREVALENCE 3rd most frequentdental emergency Representing 7-14% Affecting 6-7% Effects prognosis of tooth Gray et al 1994- 27.5% and 59.5% Mc Leod et al 1997- 37% 5
- 6. CLASSIFICATION Based on duration Based on number Based on location Based on etiology Periodontitis related Non- periodontitis related 6
- 7. PERIODONTITIS RELATED ABSCESS Activeperiodontal destruction Exacerbation of a chronic lesion Post therapy periodontal abscess Post scaling Post surgery Post antibiotic(Topoll in 1990) (Helevou et al in 1993-broad spectrum antibiotics) 7
- 8. Four types ofabscess associated with periodontal tissues Gingival abscess Peri-coronal abscess Combined periodontal/ endodontic Lateral Periodontal abscess 8 {Periodontal abscess: A review Punit Vaibhav Patel, Sheela Kumar G, Amrita Patel}
- 9. NON PERIODONTITIS RELATEDABSCESS Impaction of foreign body Orthodontic devices Root morphology alterations Invaginated root(Chen et al in 1990) Fissured root(Goose 1981) Root tears(Haney et al 1992) Endodontic perforations(Abrams et al 1992) 9
- 10. ETIOLOGY OF PERIODONTALABSCESS Etiology Environmental factors Microbiological factors Other local factors 10
- 11. ENVIRONMENTAL FACTORS Pocket Pre existingpocket Major factor Deeper, narrower, tortuous 11
- 12. MICROBIOLOGY Anaerobes (Newman& Sims) P. gingivalis- 50-100%(Topoll et al in 1990) F nucleatum B forsythus P gingivalis P intermedia Periodontal pathogens usually isolated from periodontal abscess 12
- 13. Herrera et alin 2000- 45% anaerobes resembles periodontitis microbiota Polymicrobial, non motile, gram negative, rod shaped anaerobes Ashimoto et al- P gingivalis Other microbes include P intermedia P melaninogenica F nucleatum B forsythus Spirochetes 13
- 14. VIRUSES IN PERIODONTALABSCESS Saygun et al in 2004- CMV and EBV1 14
- 15. OTHER LOCAL FACTORS Foreignmaterial such as 1. Pop-corn husk 2. Impacted food 3. Fish bone 4. Tooth brush bristles 5. Irrigating devices ANACHORETIC EFFECT 15
- 16. DIABETES AND PERIODONTALABSCESS Low host resistance Decreased chemotaxis/ phagocytosis Altered collagen metabolim 16
- 17. PATHOGENESIS Entry of bacteriainto soft tissue wall Trauma to the orifice of the periodontal pocket Formation of infiltrate Destruction of connective tissues Pus formation Decreased tissue resistance Virulence and number of bacteria 17
- 18. HISTOPATHOLOGY De Witt etal in 1985 18
- 19. CLINICAL FEATURES ANDDIAGNOSIS Acute Abscess Localized red, ovoid swelling Periodontal pocket Mobility Tooth elevation in socket Tenderness to percussion or biting Exudation Elevated temperature Regional lymphadenopathy (Smith and Davies „86) 19
- 20. Chronic Abscess Nopain or dull pain Localized inflammatory lesion Slight tooth elevation Intermittent exudation Fistulous tract often associated with a deep pocket Usually without systemic involvement 20
- 21. Herrera et alin 2000- blood and urine samples- reported 30%- elevated leukocytes and 20-40% neutrophils and monocytes 21
- 22. DIFFERENTIAL DIAGNOSIS Peri apicalabscess Manifestation of systemic disease Incomplete tooth fracture Pericoronitis Periodontal cysts 22
- 23. MANAGEMENT OF PERIODONTAL ABSCESS Thetreatment of the periodontal abscess usually includes two stages: (1) The management of the acute lesion, and (2) The appropriate treatment of the original and/or residual lesion, once the emergency situation has been controlled 23
- 24. THE MANAGEMENT OFTHE ACUTE LESION Draining the abscess with digital pressure Incision and drainage (Ahl et al 1986) Scaling and root planing 24
- 25. THE APPROPRIATE TREATMENTOF THE ORIGINAL AND/OR RESIDUAL LESION Periodontal surgery The use of different systemically administered antibiotics, and Tooth extraction. 25
- 26. ANTIBIOTICS Antibiotic Options forPeriodontal Infections1 Antibiotic of Choice Amoxicillin, 500 mg 1.0-g loading dose, then 500 mg tid, 3 days Penicillin Allergy Clindamycin 600-mg loading dose, then 300 mg qid, 3 days Azithromycin (or clarithromycin) 1.0-g loading dose, then 500 mg qid, 3 days 26
- 27. Smith and Daviesin 1986- metranidazole (200mg tid 5days) Herrera et al in 1994- tetracycline therapy There was a rapid control of pain levels, reduction in edema, redness and swelling, periodontal probing depth were significantly reduced. Gingivectomy Surgical flaps 27
- 28. CLENCHING ABSCESS 28 CASE REPORT BYKRITHIKA ET AL IN 2011
- 29. RECENT STUDIES If untreatedthe periodontal abscess may lead to cervicofacial necrotizing fasciitis Medeiros et al 2012 Orthodontic Elastic Separator-Induced periodontal Abscess: A Case Report 29 Talia Becker and Alex Neronov in 2012
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- 31. REFERENCES Newman, Takei, Klokkevld,Carranza,; Carranza‟s clinical periodontology. 10th Ed. 714 Jan Lindhe, Niklaus P Lang, T Karring; Clinical periodontology and implant dentistry 5th ed “Periodontal Abscess”- A Review - (2000) Herrera. D, Journal of Clinical Periodontology: 27; 377-387. “Periodontal Abscess” etiology and classification-(1999)Meng H. - Annals of Periodontology;79-82 “Predominant Cultivable Microbiota”- Newman et al.(1979).Journal of Periodontology;27;350-354 Ashimoto. PCR detection of Periodontal/ endodontal pathogens associated with abscess formation (1998) - 31 Journal of Dental Research 77; 854-858.
- 32. Topoll HH, LangeDE and Miller RF: Multiple periodontal abscesses after systemic antibiotic therapy. J Clin Periodontol 1990; 17: 268-272. Krithiga Gurumoorthy, Babitha Ajjappa, Shobha Prakash; multiple acute periodontal abscesses due to clenching.: Journal of Interdisciplinary Dentistry / Jan-Jun 2011 / Vol-1 / Issue-1 Saygun I, Yapar M, ozdemir A, Kubar A, Slots J. Human cytomegalo virus and Ebstien Barr virus type 1 in periodontal abscesses: oral microbiol Immunol 2004: 19: 83-87 Cervicofacial necrotizing fasciitis following periodontal abscess. Medeiros Junior, Rui De Sousa Catunda, IvsonVieira Queiroz, Isaac Henrique Araujo de Morais, Hecio Carneiro Leao, Jair Alcino Monteiro Gueiros, Luiz: general dentistry jul/aug 2012. Vol 60 issue 4, 316-321 Norhidayah, Khamiza What Expert Says … Periodontal Abscess Malaysian Dental Journal (2008) 29(2) 154-157 Obradović R. Radmila, Kojović B. Draginja, Branković R. Vesna: The Therapy Of Periodontal Abscess: Acta Stomatologica Naissi, Jun/June 2008, Vol. 24, Broj/Number 57. Talia Becker and Alex Neronov: Orthodontic Elastic Separator-Induced Periodontal Abscess: A Case Report; case reports in dentistry 2012 32
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