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Local treatment of periodontal abscess brief report.


The periodontal abscess has been recognized as a distinct clinically entity and is defined as a localized purulent inflammation of the periodontal tissues [1]. It can be present either as an acute or chronic abscess but is usually an acute exacerbation of chronic periodontal disease [2]. Among several acute conditions that can occur in periodontal tissues, the periodontal abscess deserves special attention. Besides requiring immediate attention to relieve pain, systemic complications can also be avoided with the implementation of adequate treatment. The presence of a periodontal abscess can modify the prognosis of the involved tooth and, in many cases, be responsible for its removal [3].

The abscess may occur as a direct response to an increase in virulence of the commensal organisms and the release of their associated toxins. Alrternatively, it may occur secondary to reduced host resistance [4].

The most common cause of periodontal abscess is occlusion of the orifice of the periodontal pocket. This may be due to trauma to the pocket, or impaction of food, calculus or foreign body into the

opening of the pocket [5]. Such blockage prevents drainage of exudate which results from the inflammatory reaction and is frequently seen in pockets having narrow, tortuous paths associated with furcations and deep infra-bony defects.

A periodontal abscess is defined as: "An acute, destructive process in the periodontium resulting in localised collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp" [6]. A periodontal abscess is located in the gums, not the bone, and it is caused by periodontal disease. If untreated, it can destroy the underlying bone by creating craters in the bone around the teeth [7].

An abscess forms when the pocket deepens to the point that plaque bacteria, tartar and food become trapped within it, and the body's immune system cannot adequately combat the infection. A large swelling develops on the gums as a result of this uncontrolled, rapid growth of bacteria, bacterial products and infected gum tissue. As a result, what occurs is a fast, painful destruction of the supporting connective tissue and bone that surround the tooth [8].

Case description

A 44 year old male patient was referred from Private practice of Endodontics to the Department of Periodontology and Oral Medicine of Dental Clinic in Nis, for opinion regarding the persistent gingival swelling and pain in relation to lower right first molar. A comprehensive medical and dental history was taken. The patient was found to be a Type II diabetic, under medication for the past five years.

The patient, for the first time, came to Dental Clinic four years ago, with active and advanced periodontal disease. At this time, it was predicted that the long term prognosis of the remaining teeth was guarded. Initial phase therapy, comprising oral hygiene instruction, scaling and polishing was commenced. The patient responded well and subsequently he has been under six-mounths maintenance care.

This time on clinical examination, he presented with a red, soft, diffuse gingival swelling involving the facial and lingual aspect of the mandibular right first molar. A purulent exudate was elicited on digital pressure The tooth was tender on percussion and exhibited grade II mobility. A localized probing depth of 8mm (mid- buccal) was recorded. The above clinical features were consistent with the diagnosis of a periodontal abscess.


To alleviate the symptoms of the patient, an immediate drainage of the purulent exudate through the pocket was done, following which the patient was placed under an antibiotic regimen for five days. To make the site more amenable for surgery, clindamycin-gel were placed locally in 46. Three days after the initial visit, a thorough oral prophylaxis and periodontal surgery--flap surgery in 46 was performed.

At the recall visit one week later, a sufficient resolution of the clinical signs of inflammation was not present, but a reduction in mobility to grade I was evident.

Two weeks following surgical treatment, the area was healing satisfactory with no evidence of reccurrent infection. Three weeks following surgery, complete healing in the surgical site was observed. At the three-mounthly review, the area had healed well and no problems were identified.





A case of chronic periodontal abscess tracking to a site distant from the origin has been reported. The case demonstrated that the diagnosis of deep infrabone periodontal pocket can be challenging for a clinician. The prognosis of such a tooth depends on the nature of the abscess and the extent of bone loss. Chronic periodontal abscesses, which are usually long standing, suffer slow progressive loss of bone [9]. They are more difficult to treat especially when the furcation is involved. In the case described, the bone loss was quite extensive.

A lateral periodontal abscess is a result of rapidly-growing within a periodontal pocket. A periodontal pocket forms in the presence of periodontal disease, as the gums become infected and pull away from the surface of the teeth. This deepens the sulcus--the space between the teeth and gums to a space greater than three millimeters [10].

The case described here is a deep infrabone periodontal pocket masquerading as a periodontal abscess. Early diagnosis of the deep infrabone periodontal pocket is based on clinical findings. They include discomfort and pain while biting and chewing, and noticeable gingival swelling around the tooth. Once a periodontal abscess has been diagnosed, emergency treatment needs to be provided to resolve the infection. Drainage is usually achieved through the pocket as part of the root planing procedure to clean the plaque and calculus deposits from the root surfaces [11]. After adequate anaesthesia has been achieved, drainage can be started by inserting a sharp curette to the base of the abscess [12].

Some authors [13,14], studied the behaviour of abscesses after therapy. They studied 62 periodontal abscesses. In 22 of them, the acute phase was treated surgically by incision and drainage, along with the administration of systemic metronidazole (200 mg, 5 days). At a later stage, periodontal therapy was carried out, including oral hygiene procedures with the help of clorhexidine, scaling and root planing, and if necessary, periodontal surgery. Out of the 22 treated teeth, 14 were extracted for periodontal reasons within the 3 years of follow-up, while only 8 teeth were still in place.

In the treatment of chronic periodontal abscesses, surgical therapy (either gingivectomy or flap procedures) has also been advocated, [6] mainly in abscesses associated with deep vertical defects, where the resolution of the abscess may only be achieved by a surgical operation [15]. Surgical flaps have also been proposed in cases in which calculus is left subgingivally after the treatment. The main objective of the therapy is to eliminate the remaining calculus and obtain drainage at the same time [16,17].

In the past, periodontal abscess and tooth who's involved were considered to have a hopeless prognosis and were extracted. In recent times, several treatment options have been tried out including use of surgical procedures [18], topical administration of antibiotics [19,20] and laser therapy [21,22]. The above mentioned treatment methods have good success rate in the presence of a weakened periodontium. The most predictable treatment alternative is modified Widman flap 16 followed by fixed prosthesis. Therefore, early and correct diagnosis is imperative, as delay will result in rapid loss of supporting bone and eventually tooth loss.


[1.] Carranza, F.A., 1990. Glickman's clinical periodontology. 7th ed. WB, Saunders Company, Philadelphia.

[2.] McFall, W.T., 1964. The periodontal abscess. J North Carolina Dent Soc., 47: 24-29.

[3.] Herrera, D., S. Roldan, M. Sanz, 2000. The periodontal abscess: a review. J Clin Periodontol., 27: 377-386.

[4.] Peterson, D.E., G.E. Minah, D. Overholser, J.B. Suzuki, L.G. DePaola, D.M. Stansbury, L.T. Williams, S.C. Schimpff, 1987. Microbiology of acute periodontal infection in myelosuppressed cancer patients. J Clin Oncol., 5: 1461-1468.

[5.] Dello Russo, N.M., 1985. The post-prophylaxis periodontal abscess: Etiology and treatment. Int J Perio Res Dent., 1: 29-35.

[6.] Lang, N.P., M.S. Tonneti, 2003. Periodontal risk assessment (PRA) for patients in supporative periodontal therapy (SPT). Oral Health Prev Dent., 1: 7-16.

[7.] McLeod, D.E., P.A. Lainson, J.D. Spivey, 1997. Tooth loss due to periodontal abscess: a retrospective study. J Periodontol., 68: 963-966.

[8.] Chen, R.J., J.F. Yang, C. hao, T.C. Invaginated, 1990. tooth associated with periodontal abscess. Oral Surg Oral Med Oral Pathol., 69: 659-660.

[9.] Mueller, H.P., 2005. Periodontology--the Essentials. Thieme, Stuttgart-New York.

[10.] Palmer, R.M., 1984. Acute lateral periodontal abscess. Br Dent J., 157: 311-313.

[11.] Hafstrom, C.A., M.B. Wikstrom, S.N. Renvert, G.G. Dahlen, 1994. Effect of treatment on some periodontopathogens and their antibody levels in periodontal abscesses. J Periodontol., 65: 10221028.

[12.] Cobb, C.M., 2002. Clinical significance of nonsurgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Perio., 29(2): 6-16.

[13.] Smith, R.G., R.M. Davies, 1986. Acute lateral periodontal abscesses. Br Dent J., 161: 176-178.

[14.] Fine, D.H., 1994. Microbial identification and antibiotic sensitivity testing, an aid for patients refractory to periodontal therapy. J Clin Periodontol., 21: 98-106.

[15.] Kareha, M.J., E.S. Rosenberg, H. DeHaven, 1981. T herapeutic considerations in the management of a periodontal abscess with an intrabony defect. J Clin Periodontol., 8: 375-386.

[16.] Cortellini, P., G.P. Prato, M.S. Tonetti, 1999. The simplified papilla preservation flap. A novel Surgical approach for the management of soft tissue in regenerative procedures. Int J Periodontics Restorative Dent., 19: 589-599.

[17.] Pejcic, A., 2005. Comparative analisis of low level laser therapy and conseravative therapy of gingival inflammation.[Master thesis]. Nis. University of Nis, Medical Faculty.

[18.] Nyman, S., J. Lindhe, T. Karring, H. Rylander, 1982. New attachment following surgical treatment of human periodontal disease. J Clin Perio., 9: 290-296.

[19.] Oringer, R.J., K.F. Al-Shammori, W.A. Aldredge et al., 2002. Effect of locally delivered minocycline microspheres on marcers of bone resorption. J Perio., 73: 835-842.

[20.] Quirynen Marc., Teughels Wim, de Soete Marc, 2000. van Steenberghe Daniel. Topical antiseptics and antibiotics in the initial therapy of chronic adult periodontitis: microbiological aspects. Perio., 28(1): 72-90.

[21.] Pejcic, A., D. Grujicic, 2007. Primena lasera male snage u lecenju parodontopatije. Vojnosanit Pregl., 64(12): 845-850.

[22.] Pejcic, A., V. Zivkovic, 2007. Histological Examination of Gingiva Treated with Low-level Laser in Periodontal therapy. Journal of Oral Laser Apllications, 7: 37-43.

(1) Ana Pejcic, DMD, MhD, (2) Dragan Vujicic, DMD, (3) Dimitrije Mirkovic DMD

(1) Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis, Bul. dr Z. Djindjica 81, 18000 Nis, Serbia

(2) Millitary Medical Academy, University of Belgrade, Velikotrnavska 17, 11000 Beograd, Serbia

(3) Dentistry Group, Medical Faculty, University of Nis, Bul. dr Z. Djindjica 81, 18000 Nis, Serbia

Corresponding Author

Ana Pejcic, Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis, Bul. dr Z. Djindjica 81, 18000 Nis, Serbia

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Title Annotation:Original Article
Author:Pejcic, Ana; Vujicic, Dragan; Mirkovic, Dimitrije
Publication:Advances in Medical and Dental Sciences
Article Type:Report
Geographic Code:1USA
Date:May 1, 2009
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