Periodontal abscess - Wikipedia

A periodontal abscess is a localized collection of pus (i.e. an abscess) within the tissues of the periodontium. It is a type of dental abscess. Periodontalabscess FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Thisarticleneedsadditionalcitationsforverification.Pleasehelpimprovethisarticlebyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.Findsources: "Periodontalabscess" – news ·newspapers ·books ·scholar ·JSTOR(May2016)(Learnhowandwhentoremovethistemplatemessage) MedicalconditionPeriodontalabscessAgingivalabscessbetweenthelowerleftcanineandfirstpremolar.SpecialtyDentistry  Aperiodontalabscess(alsotermedlateralabscess,[1]orparietalabscess),[1]isalocalizedcollectionofpus(i.e.anabscess)withinthetissuesoftheperiodontium.Itisatypeofdentalabscess.Aperiodontalabscessoccursalongsideatooth,andisdifferentfromthemorecommon[2]periapicalabscess,whichrepresentsthespreadofinfectionfromadeadtooth(i.e.whichhasundergonepulpalnecrosis).Toreflectthis,sometimestheterm"lateral(periodontal)abscess"isused.Incontrasttoaperiapicalabscess,periodontalabscessesareusuallyassociatedwithavital(living)tooth.Abscessesoftheperiodontiumareacutebacterialinfections[3]classifiedprimarilybylocation.[4] Contents 1Signsandsymptoms 2Causes 3Diagnosis 3.1Classification 4Treatment 5References 6Externallinks Signsandsymptoms[edit] Themainsymptomispain,whichoftensuddenlyappears,andismadeworsebybitingontheinvolvedtooth,whichmayfeelraisedandprominentinthebite.Thetoothmaybemobile,andthelesionmaycontributetodestructionoftheperiodontalligamentandalveolarbone.[4]Thepainisdeepandthrobbing.Theoralmucosacoveringanearlyperiodontalabscessappearserythematous(red),swollenandpainfultotouch.[3]Thesurfacemaybeshinyduetostretchingofthemucosaovertheabscess.Beforepushasformed,thelesionwillnotbefluctuant,andtherewillbenopurulentdischarge.Theremayberegionallymphadenitis. Whenpusforms,thepressureincreases,withincreasingpain,untilitspontaneouslydrainsandrelievesthepain.Whenpusdrainsintothemouth,abadtasteandsmellareperceived.Usuallydrainageoccursviatheperiodontalpocket,orelsetheinfectionmayspreadasacellulitisorapurulentodontogenicinfection.Localanatomicfactorsdeterminethedirectionofspread(seefascialspacesoftheheadandneck).Theremaybesystemicupset,withanonsetofpainandfever. Causes[edit] Thissectiondoesnotciteanysources.Pleasehelpimprovethissectionbyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.(May2016)(Learnhowandwhentoremovethistemplatemessage) Aperiodontalabscessmostcommonlyoccursasacomplicationofadvancedperiodontaldisease(whichisnormallypainless).Aperiodontalpocketcontainsdentalplaque,bacteriaandsubgingivalcalculus.Periodontalpathogenscontinuallyfindtheirwayintothesofttissues,butnormallytheyareheldincheckbytheimmunesystem.Aperiodontalabscessrepresentsachangeinthisbalance,relatedtodecreasedlocalorsystemicresistanceofthehost.Aninflammatoryresponseoccurswhenbacteriainvadeandmultiplywithinthesofttissueofthegingivalcrevice/periodontalpocket.Apus-filledabscessformswhentheimmunesystemrespondsandattemptstoisolatetheinfectionfromspreading. Communicationwiththeoralenvironmentismaintainedviatheopeningoftheperiodontalpocket.However,iftheopeningofaperiodontalpocketbecomesobstructed,asmayoccurifthepockethasbecomeverydeep(e.g.withfurcationinvolvement),thenplaqueandcalculusaretrappedinside.Foodpackingmayalsoobstructaperiodontalpocket.Foodpackingisusuallycausedbyfailuretoaccuratelyreproducethecontactpointswhendentalrestorationsareplacedontheinterproximalsurfacesofteeth.Anotherpotentialcauseoccurswhenaperiodontalpocketisscaledincompletely.Followingthisprocedure,thegingivalcufftightensaroundthetooth,whichmaybeenoughtotrapthebacterialeftinthepocket.Agingivalretractioncordwhichisaccidentallyleftinsituisanoccasionalcauseofaperiodontalabscess. Penetratinginjurytothegingiva--forexample,withatoothbrushbristle,fishbone,toothpickorperiodontalinstrument--mayinoculatebacteriaintothetissues.Traumatothetissues,suchasseriousimpactonatoothorexcessivepressureexertedonteethduringorthodontictreatment,canbeapossiblecauseaswell.Occlusaloverloadmayalsobeinvolvedinthedevelopmentofaperiodontalabscess,butthisisrareandusuallyoccursincombinationwithotherfactors.Bruxismisacommoncauseofexcessiveocclusalforces. Systemicimmunefactorssuchasdiabetescanpredisposeapersontotheformationofperiodontalabscesses. Perforationofarootcanalduringendodontictherapycanalsoleadtoaperiodontalabscess. Diagnosis[edit] Periodontalabscessesmaybedifficulttodistinguishfromperiapicalabscesses.Sincethemanagementofaperiodontalabscessisdifferentfromaperiapicalabscess,thisdifferentiationisimportanttomake(seeDentalabscess#Diagnosticapproach)Forexample,rootcanaltherapyisunnecessaryandhasnoimpactonpaininaperiodontalabscess. Classification[edit] Therearefourtypesofabscessesthatcaninvolvetheperiodontaltissues:[3] Gingivalabscess—alocalized,purulentinfectioninvolvesonlythesoftgumtissuenearthemarginalgingivaortheinterdentalpapilla.[3] Periodontalabscess—alocalized,purulentinfectioninvolvingagreaterdimensionofthegumtissue,extendingapicallyandadjacenttoaperiodontalpocket.[3] Pericoronalabscess—alocalized,purulentinfectionwithinthegumtissuesurroundingthecrownofapartiallyorfullyeruptedtooth.[3]Usuallyassociatedwithanacuteepisodeofpericoronitisaroundapartiallyeruptedandimpactedmandibularthirdmolar(lowerwisdomtooth). combinedperiodontal/endodonticabscess Treatment[edit] Thissectiondoesnotciteanysources.Pleasehelpimprovethissectionbyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.(May2016)(Learnhowandwhentoremovethistemplatemessage) Animportantfactoriswhethertheinvolvedtoothistobeextractedorretained.Althoughthepulpisusuallystillvital,ahistoryofrecurrentperiodontalabscessesandsignificantlycompromisedperiodontalsupportindicatethattheprognosisforthetoothispooranditshouldberemoved. Theinitialmanagementofaperiodontalabscessinvolvespainreliefandcontroloftheinfection.Thepusneedstobedrained,whichhelpsbothoftheseaims.Ifthetoothistoberemoved,drainagewilloccurviathesocket.Otherwise,ifpusisalreadydischargingfromtheperiodontalpocket,thiscanbeencouragedbygentleirrigationandscalingofthepocketwhilstmassagingthesofttissues.Ifthisdoesnotwork,incisionanddrainageisrequired,asdescribedinDentalabscess#Treatment. Antibioticsareofsecondaryimportancetodrainage,whichifsatisfactoryrendersantibioticsunnecessary.Antibioticsaregenerallyreservedforsevereinfections,inwhichthereisfacialswelling,systemicupsetandelevatedtemperature.Sinceperiodontalabscessesfrequentlyinvolveanaerobicbacteria,oralantibioticssuchasamoxicillin,clindamycin(inpenicillinallergyorpregnancy)and/ormetronidazolearegiven.Ideally,thechoiceofantibioticisdictatedbytheresultsofmicrobiologicalcultureandsensitivitytestingofasampleofthepusaspiratedatthestartofanytreatment,butthisrarelyoccursoutsidethehospitalsetting. Othermeasuresthataretakenduringmanagementoftheacutephasemightincludereducingtheheightofthetoothwithadentaldrill,soitnolongercontactstheopposingtoothwhenbitingdown;andregularuseofhotsaltwatermouthwashes(antiseptic)thatencouragesfurtherdrainageoftheinfection. Themanagementfollowingtheacutephaseinvolvesremovinganyresidualinfection,andcorrectingthefactorsthatleadtotheformationoftheperiodontalabscess.Usually,thiswillbetherapyforperiodontaldisease,suchasoralhygieneinstructionandperiodontalscaling. References[edit] ^abNewmanMG,TakeiHH,KlokkevoldPR,CarranzaFA,eds.(2012).Carranza'sclinicalperiodontology(11th ed.).St.Louis,Mo.:Elsevier/Saunders.p. 137.ISBN 978-1-4377-0416-7. ^HuppJR,EllisE,TuckerMR(2008).Contemporaryoralandmaxillofacialsurgery(5th ed.).St.Louis,Mo.:MosbyElsevier.p. 293.ISBN 9780323049030. ^abcdefAmericanAcademyofPeriodontology(May2000)."Parameteronacuteperiodontaldiseases.AmericanAcademyofPeriodontology"(PDF).J.Periodontol.71(5Suppl):863–6.doi:10.1902/jop.2000.71.5-S.863.PMID 10875694.Archivedfromtheoriginal(PDF)on2010-11-28. ^abAmericanAcademyofPeriodontology(1999)."Consensusreport:AbscessesofthePeriodontium".Ann.Periodontol.4(1):83.doi:10.1902/annals.1999.4.1.83. Externallinks[edit] ClassificationDICD-10:K05.2MeSH:D005491 vteDentistryinvolvingsupportingstructuresofteeth(Periodontology)Anatomy Periodontium Alveolarbone Biologicwidth Bundlebone Cementum Freegingivalmargin Gingiva Gingivalfibers Gingivalsulcus Junctionalepithelium Mucogingivaljunction Periodontalligament Sulcularepithelium Stippling DiseaseDiagnoses Chronicperiodontitis Localizedaggressiveperiodontitis Generalizedaggressiveperiodontitis Periodontitisasamanifestationofsystemicdisease Periodontosis Necrotizingperiodontaldiseases Abscessesoftheperiodontium Combinedperiodontic-endodonticlesions Infection A.actinomycetemcomitans Capnocytophagasp. F.nucleatum P.gingivalis P.intermedia T.forsythia T.denticola Redcomplex Entamoebagingivalis(amoebic) Trichomonastenax Other Calculus Clinicalattachmentloss Edentulism Fremitus Furcationdefect Gingivalenlargement Gingivalpocket Gingivalrecession Gingivitis Horizontalbonydefect Lineargingivalerythema Occlusaltrauma Periodontalpocket Periodontaldisease Periodontitis Plaque Verticalbonydefect Treatmentandprevention Periodontalexamination Ante'slaw Brushing Bleedingonprobing Chlorhexidinegluconate Flossing Hydrogenperoxide Mouthwash Oralhygiene Tetracycline Triclosan Hostmodulatorytherapy TreatmentConventionaltherapy Debridement Scalingandrootplaning Fullmouthdisinfection Fullmouthultrasonicdebridement Surgery Apicallypositionedflap Bonegraft Coronallypositionedflap Crownlengthening Freegingivalgraft Gingivalgrafting Gingivectomy Guidedboneregeneration Guidedtissueregeneration Enamelmatrixderivative Implantplacement Lateralpediclegraft Openflapdebridement Pocketreductionsurgery Socketpreservation Sinuslift Subepithelialconnectivetissuegraft Tools Curette Membrane Probe Scaler Importantpersonalities TomasAlbrektsson FrankBeube Per-IngvarBrånemark RobertGottsegen GaryGreenstein JanLindhe BrianMealey PrestonD.Miller WilloughbyD.Miller CarlE.Misch JohnMankeyRiggs JaySeibert JørgenSlots PaulRoscoeStillman DennisP.Tarnow Hom-LayWang JamesLeonWilliams W.J.Younger Otherspecialties Endodontology Orthodontology Prosthodontology Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Periodontal_abscess&oldid=996172098" Categories:BacterialdiseasesPeriodontaldisordersHiddencategories:ArticlesneedingadditionalreferencesfromMay2016AllarticlesneedingadditionalreferencesArticleswithshortdescriptionShortdescriptionmatchesWikidata Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English expanded collapsed Views ReadEditViewhistory More expanded collapsed Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages فارسیRomână Editlinks