Periodontal abscesses Case definition : A periodontal abscess is a localised accumulation of pus located within the gingival wall of the periodontal pocket/sulcus, resulting in a significant tissue breakdown. The primary detectable signs or symptoms associated with a periodontal abscess may involve ovoid elevation in the gingiva, along the lateral part of the root, and bleeding on probing. Other signs and symptoms include pain, suppuration on probing, deep periodontal pockets, and increased tooth mobility. A periodontal abscess may develop in a pre-existing periodontal pocket – for example, in patients with untreated periodontitis, under supportive therapy, after scaling and root planing, or after systemic antimicrobial therapy. A periodontal abscess occurring at a site that was previously periodontally healthy is commonly associated with a history of impaction or harmful habits. • The design, fabrication, delivery, and materials used for tooth-supported/retained restorations and fixed dental prosthetic procedures can be associated with plaque retention, gingival recession, and loss of periodontal supporting tissue. • Tooth anatomical factors (i.e. cervical enamel projections, enamel pearls, developmental grooves), root proximity, abnormalities and fractures, and tooth relationships in the dental arch are related to gingival inflammation induced by dental-plaque biofilm and loss of periodontal supporting tissues.
Classification of periodontal abscesses based on the aetiological factors involved
Untreated periodontitis Non-responsive to periodontitis therapy Supportive periodontal therapy
Acute exacerbation
Periodontal abscess in periodontitis patients (in a pre-existing periodontal pocket)
Post-scaling Post-surgery
After treatment
Other drugs: nifedipine Systemic antimicrobials Dental floss, orthodontic elastic, toothpick, rubber dam or popcorn hulls Wire or nail biting and clenching Orthodontic forces or a cross-bite
Post-medication
Impaction
Harmful habits
Orthodontic factors
Periodontal abscess in non periodontitis patients (not mandatory to have a a pre-existing periodontal pocket)
Gingival overgrowth
Invaginated tooth, dens evaginatus , or odontodysplasia
Severe anatomic alterations
Minor anatomic alterations
Cemental tears, enamel pearls, or development grooves
Alteration of root surface
Iatrogenic conditions Severe root damage
Perforations
Fissure or fracture, cracked-tooth syndrome
Post-surgery
Systemic and other periodontal conditions
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Guidance for clinicians
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