Differential Diagnosis between periapical and peri

Differential Diagnosis between Periapical and Periodontal Abscess : 

Differential Diagnosis between Periapical and Periodontal Abscess

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An abscess: is a collection of pus that is usually caused by a . bacterial infection. *Pus enclosed enclosed inside the abscess consists of white blood cells, dead tissue cells and bacteria . *So it is considered to be a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body .

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Mechanism of abscess formation : * The organisms or foreign materials kill the local cells, resulting in the release of cytokines. * The cytokines trigger an inflammatory response, which draws large numbers of white blood cells to the area and increases the regional blood flow. *The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighbouring structures.

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* However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.

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Dental abscess A dental abscess occurs when bacteria infect and spread inside the tooth. There are three types of dental abscess: *A gingival abscess that involves only the gum tissue, without affecting either the tooth or the periodontal ligament. *A periapical abscess that starts in the dental pulp. *A periodontal abscess that begins in the supporting bone and the PDL of the teeth.

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Periapical and periodontal abscesses differ in the way in which plaque bacteria infect a tooth. However, periapical abscesses are much more common than periodontal abscesses. People with weakened immune systems can develop abscesses more often because of their low resistance to infection . People at higher risk for developing abscesses: * Chronic steroid therapy * Diabetes * Cancer *AIDS * Dialysis for kidney failure *leukemia * Chemotherapy

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Pathogenesis of a periapical abscess: *Periapical abscess usually originates from a bacterial infection that has accumulated in the pulp of the tooth. *Dental caries break down the enamel and the dentine, then reach the pulp causing pulpitis. *The bacteria continue to infect the pulp until it reaches the supporting bone (alveolar bone), where the periapical abscess forms.

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Pathogenesis of a periodontal abscess: *A periodontal abscess occurs when plaque bacteria affect the gingiva and the PDL causing periodontitis . *Periodontitis result in separation of the PDL from root of the affected tooth. * This separation creates a tiny gap known as a periodontal pocket, which can be very difficult to keep clean, and allows bacteria to enter and spread. The periodontal abscess is formed by the build up of bacteria in the periodontal pocket.

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Periodontal Abscess: * A localized purulent infection within the tissue adjacent to the periodontal pocket that may lead to the destruction of periodontal ligaments and alveolar bone. Periodontal abscesses can be acute or chronic. *Acute abscesses are painful, edematous, red, shiny, ovoid elevations of the gingival margin and/or attached gingiva. *After their purulent content is partially exuded, they become chronic. *Chronic abscesses may produce a dull pain and may at times become acute.

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Chronic periodontal abscess Acute periodontal abscess

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Symptoms : *Differ according to the type of inflammation : Acute periodontal abscess: * Pain is severe, persistent & throbbing * The gingiva becomes red, swollen and tender. * In the early stages there is no fluctuation or pus discharge. * Associated lymph nodes enlargement maybe present.

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In the chronic stages : * A nasty taste and spontaneous bleeding may accompany discomfort. * The adjacent tooth is tender to bite on and is sometimes slightly mobile. * Pus may be present and discharged from the gingival crevice or from a sinus in the mucosa overlying the affected root. * The pain is then reduced and the abscess appears as a red, shiny and tender swelling .

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Signs of periodontal abscess : *Presence of generalized periodontal disease with pocketing and bone loss. *Tooth is usually vital. *Overlying gingival erythematous, tender and swollen. *Painful at times. *Pus discharge via periodontal pocket or sinus opening. *Possible cervical lymphadenopathy.

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Radiographs: *Intra oral radiographs, include periapical and vertical bite-wing views, are used to assess marginal bone loss and perapical condition of the tooth involved. *Gutta percha point placed through sinus might locate the source of the abscess. Pulp vitality test: Thermal or electrical tests could be used to assess the vitality of the tooth