Periodontal Abscess: Definition, Causes, Symptoms, Treatment and Complications

It is a collection of pus that can occur on the gums.

It generally occurs in those affected by chronic periodontal disease (in the vast majority of cases). It is called a ‘ gingival abscess ‘ if only the gums are affected.

Tooth abscesses always require professional dental care. They occur when bacteria invade the dental pulp, the soft inner part of the tooth that contains blood vessels, nerves, and tissue.

Bacteria enter through a tooth cavity, chip or crack in the tooth, and spread to the root. Bacterial infection causes swelling and the formation of pus (bacteria, dead tissue, and white blood cells).

If left unchecked, the bacterial infection spreads from the tooth root to different parts of the body.

Common causes of periodontal abscesses

Common causes of periodontal abscesses are severe, untreated tooth decay, dental injury such as chipped or broken teeth, and gum diseases such as gingivitis or periodontitis.

Two other causes are persistent disease and infection after root canal therapy and infected tooth fillings.

Who is at risk?

Anyone who does not receive treatment for a broken tooth, an exposed root, or a deep cavity is at risk of developing a tooth abscess.

People who have not been to the dentist for a long time are especially vulnerable because they may not have received treatment for severe cavities caused by factors such as prolonged poor oral hygiene, a high-sugar diet, or financial restrictions.

People with diabetes, an autoimmune disease, or those receiving chemotherapy / radiation therapy for cancer treatment (or who have another medical condition that weakens their immune system) are also at increased risk for abscesses.

Symptoms of periodontal abscesses

A tooth abscess usually affects only one tooth, but if the infection remains untreated, other teeth can become infected as well.

To prevent serious complications that can arise from lack of treatment, it is important to see a dentist if you experience any of the following symptoms:

  • Toothache (continuous and characterized by biting, stabbing, stabbing, or throbbing sensations).
  • Bitter taste in the mouth.
  • Bad breath.
  • Discomfort.
  • Pain when chewing, especially when biting or closing the mouth forcefully.
  • Dental sensitivity to hot and cold temperatures.
  • Red, swollen gums that drain pus.
  • Swollen lymph nodes in the neck and jaw areas
  • Headaches.

If the infection kills the dental nerve, the toothache may stop. However, this does not mean that the infection has healed; The infection continues to spread and destroy tissue.

With an advanced infection, you may experience nausea, vomiting, and chills.

Fever and facial swelling may indicate that the infection has spread deeper into your jaw and surrounding tissue, or even other areas of your body.

If you can’t reach your dentist, go to an emergency room.

Treatment options for periodontal abscesses

A tooth abscess does not resolve without treatment. Even if the abscess disperses, bursts, or drains and the pain stops, you still need professional dental treatment.

Common treatments consist of the following:

Timely treatment of cavities and traumatized teeth : Treatment goals include draining the abscess, eradicating and stopping the spread of infection, preserving the tooth (whenever possible), and preventing complications.

Antibiotics: Antibiotics kill the germs responsible for dental abscesses, helping the body repair teeth and bones.

Your dentist usually prescribes antibiotics, most of them penicillin, after the x-rays have been reviewed to confirm that you have an infection.

Antibiotics are usually effective in controlling the abscess; most symptoms will ease within two days, and the abscess will usually heal after five days of antibiotic treatment.

If the infection is confined to the abscess area, antibiotics may not be necessary. However, if the infection has spread to nearby teeth, jaw, or other areas, your dentist will likely prescribe antibiotics to stop the infection from spreading.

Antibiotics may also be prescribed if you have a weakened immune system.

Warm Salt Water Rinses: If an abscess breaks out on its own, salt water rinses will soothe, help clean your mouth, and encourage drainage until you can see your dentist.

Your dentist may also recommend them during your treatment recovery time to ease discomfort and promote healing.

Over-the-counter (OTC) pain relievers : Pain relievers like ibuprofen help relieve discomfort while the area is healing.

However, while these medications will decrease pain, they will not treat the abscess. You still need to see your dentist for proper follow-up care.

Root canal treatment: This procedure can help clear the infection and save your tooth. This involves removing the diseased pulp and draining the abscess.

The pulp chamber of the tooth and root canals are filled and sealed, then capped. Root canal surgery may also be recommended to remove any diseased root tissue after the infection is gone.

This option is only recommended when enough tooth structure remains to place a permanent restoration.

Removal of the infected tooth : If the tooth cannot be restored through root canal treatment, it must be extracted. Your dentist will remove the tooth and drain the abscess to clear the infection.

Your dentist will then follow up with the scraping (removal or scraping) of all the infected soft tissues at the tip of the tooth. Tooth extraction and cleaning of the affected area will allow the wound to heal.

Surgery : An abscess that has spread to the floor of the mouth or neck may need drainage in the operating room under anesthesia.

Also, if an abscess still does not heal, or if it becomes enlarged after undergoing conventional root canal treatment, it will most likely require surgery and filling of the root tips, as well as a diagnostic biopsy.

Hospitalization: Serious tooth and jaw infections, secondary infections of the body, and their complications can be life-threatening and require an emergency room and / or long-term hospital care.

Who treats periodontal abscesses?

An oral surgeon is recommended in cases involving the extraction of diseased teeth that cannot be saved, especially when general anesthesia and / or the evaluation and treatment of pathological conditions are required.

These can be severe infections of the oral cavity, jaws and neck, reconstructive or cosmetic surgery for facial disfigurement and removal of areas of the jaw and facial tissue.

Emergency room doctors may also be required in extreme cases.

If admission to the hospital becomes necessary, a general practitioner can treat secondary infections that result from abscesses that have been left untreated for a long time or from rapidly spreading infections.

Possible complications of periodontal abscesses

An abscess can create a rash or fistulas through the skin that drips and drains pus into the mouth or on the cheek. More serious and dangerous, the abscess can burst in the bone area and spread throughout the body, infecting surrounding tissue and possibly damaging nerves as it travels.

A severe case with perforated and extended bone in the soft tissue can eventually progress to osteomyelitis (bone infection) and cellulitis (skin infection).

When left untreated, an advanced infection can destroy the jaw and lead to tooth loss and possible facial disfigurement as a result of soft and compromised facial bones.

It can put you at higher risk for systemic (whole body) problems such as diabetes flare-ups, blood infection ( septicemia ), breathing problems, heart disease, and vascular infections.

An example of a serious complication of an abscess that requires immediate hospitalization is Ludwig’s angina , a severe form of cellulitis that inflames the tissues on the floor of the mouth. In extreme cases, this condition can close the airway and cause suffocation.

The infection can also spread to the mid-chest area, which has serious consequences for vital organs such as the heart. If the abscess doesn’t drain, it can lead to sepsis, a whole-body infection that can lead to loss of a limb, organ dysfunction, and death.

In rare cases, the spread of infection to soft tissues, the jaw, and other areas of the body can cause meningitis, brain abscess, and pneumonia.