periodontal abscess

PERIODONTAL ABSCESS:

PERIODONTAL ABSCESS Submitted by- Dr. Umesh Joshi(BDS)

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DEFINITION- it’s the localized accumulation of pus within the gingival wall of a periodontal pocket. it may be acute or chronic

CLINICAL FEATURES:

CLINICAL FEATURES ACUTE FORM- *ovoid elevation of gingiva along lateral aspect * gingiva is edematous and red, with smooth and shiny surface *area may be domelike relativively firm or pointed and soft

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SYMPTOMS- throbbing, radiating pain; tenderness to palpation; tenderness to percussion; tooth mobility; lymphadenitis; fever, leukocytosis , malaise

CHRONIC FORM:

CHRONIC FORM It usually presents with SINUS that opens onto the gingival mucosa somewhere along the length of root History of INTERMITTENT EXUDATION. SINUS may be covered by a small, pink, beadlike mass of granulation tissue.

CHRONIC FORM :

CHRONIC FORM CLINICAL FEATURES- asymptomatic; dull, gnawing pain; slight elevation o f tooth; desire to bite down on.

PERIODONTAL ABSCESS:

PERIODONTAL ABSCESS orifice

PERIODONTAL ABSCESS:

PERIODONTAL ABSCESS ETIOLOGY- * DOWN EXTENSION OF INFECTION FROM POCKET * CUL-DE-SAC IS SHUT OFF * INCOMPLETE CALCULUS REMOVAL * PERFORATION OF LATERAL ROOT

DIAGNOSIS:

DIAGNOSIS Correlation of history and clinical and radiographic findings. DETECT a CHANNEL from marginal area to deeper periodontal tissues.( gutta percha ) SINUS ORIFICE along the gingiva (root) Pulp vitality tests

TREATMENT:

TREATMENT DRAINAGE through pocket with help of CURETTE . DRAINAGE through an external incision ANTIBIOTIC THERAPY

ANTIBIOTIC THERAPY:

ANTIBIOTIC THERAPY The common antibiotics used are Phenoxymethylpenicillin 250 -500 mg qid 5/7 Amoxycillin 250 - 500 mg tds 5-7 days Metronidazole 200 - 400 mg tds 5-7 days If allergic to penicillin Erythromycin 250 –500 mg qid 5-7 days Doxycycline 100mg bd 7-14 days Clindamycin 150-300 mg qid 5-7 days

GINGIVAL ABSCESS:

GINGIVAL ABSCESS DEFINITION- localized, painful expanding lesion that is usually of sudden onset. Limited to marginal gingiva or interdental papilla.

GINGIVAL ABSCESS:

GINGIVAL ABSCESS CLINICAL FEATURES- EARLY STAGES: red swelling with a smooth, shiny surface. 24 to 48 HOURS: lesion becomes fluctuant and pointed with ORIFICE from which a PURULENT EXUDATE is expressed.

GINGIVAL ABSCESS:

GINGIVAL ABSCESS

GINGIVAL ABSCESS:

GINGIVAL ABSCESS ETIOLOGY- BACTERIA carried deep into tissues through toothbrush BRISTLE, APPLE CORE, LOBSTER SHELL FRAGMENT

Periodontal Vs. Periapical Abscess :

Periodontal Vs. Periapical Abscess Periodontal Abscess – Vital tooth – No caries – Pocket – Lateral radiolucency – Mobility – Percussion sensitivity variable – Sinus tract opens via keratinized gingiva Periapical Abscess – Non-vital tooth – Caries – No pocket – Apical radiolucency – No or minimal mobility – Percussion sensitivity – Sinus tract opens via alveolar mucosa

Pericoronal Abscess:

Pericoronal Abscess A localized purulent infection within the tissue surrounding the crown of a partially erupted tooth . Most common adjacent to mandibular 3rd molars in young adults; usually caused by impaction of debris under the soft tissue flap

Pericoronal Abscess:

Pericoronal Abscess Clinical Features Operculum (soft tissue flap) Localized red, swollen tissue Area painful to touch Tissue trauma from opposing tooth common Purulent exudate , trismus , lymphadenopathy , fever, and malaise may be present

Treatment Options :

Treatment Options Debride /irrigate under pericoronal flap Tissue recontouring (removing tissue flap) Extraction of involved and/or opposing tooth Antimicrobials (local and/or systemic as needed ) Culture and sensitivity Follow-up

DIFFERENTIAL DIAGNOSIS:

DIFFERENTIAL DIAGNOSIS PERIODONTAL ABSCESS-(W/O SINUS) GINGIVAL ABSCESS PERIAPICAL ABSCESS FIBROMA GRANULOMA PERIODONTAL ABSCESS-(WITH SINUS) DEEP DEGRADED ULCER

Referrences:

Referrences Carranza 10 th edition.Periodontal lesions &Treatment of periodontal abscess. Dimitroulis 1997. A synopsis of minor oral surgery. Reed education & Professional publication Ltd. Chapter 8 ( Odontogenic infections) Lewis MAO, MacFarlane TW. Short –course high-dosage amoxycillin in the treatment of acute dentoalveolar abscess

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THANX