Periodontal Abscesses Research Paper

Dental abscesses are one of the most common dental ailments, and they are one of the top three dental emergencies. Periodontal abscesses are just one of the many types of dental abscesses. Periodontal abscesses are bacterial infections confined to areas of the periodontium usually in deep periodontal pockets, but can also be caused by trauma. The infection causes a build up of pus leading to some uncomfortable signs and symptoms. Some which include swelling of the gingiva, throbbing pain, exudate discharge, foul smelling breath, fever and much more. It is important for the dental professional to correctly diagnose the periodontal abscess so that they can provide the correct treatment. Some treatment methods include draining and irrigation of the infection, surgery, extraction of the tooth, systemic or local antibiotics, and biofilm decontamination. Once a periodontal abscess has been treated it is up to the patient to prevent future infections by maintaining good oral care at home and seeking dental cleanings such as scaling and root planing if needed.

Periodontal Abscesses
Dental abscesses are one of the most common ailments in dentistry.

A dental abscess is a contained infection caused by pathogenic bacteria that forms a space of pus and leads to issues in the periodontium. There are many types of abscesses that can occur in the oral cavity, one of most common being the periodontal abscess. To understand periodontal abscesses its important to know what they are and why they are caused, signs and symptoms, and how they can be

treated.
A periodontal abscess is an area of infection caused by bacteria that is formed in the periodontal ligaments (PDL) that surround a tooth. An even more detailed explanation states that they are lesions found in the gingival wall of periodontal pockets that have broken down in a short amount of time causing accumulation of pus (Herrera, Alonso, Arriba, Santa Cruz, Serrano, & Sanz, 2014, p.149). “Studies by the American Academy of Periodontology (AAP) found that periodontal abscesses are commonly found in the mandibular and maxillary first molars, maxillary incisors, and the cuspids, followed by the maxillary second molars” (Ovard, 2013). A periodontal abscess is commonly caused by current periodontitis, which allows bacteria to invade the deep pockets and other surrounding periodontium. Some of the greatest communal bacteria associated with the periodontal abscesses are strict anaerobes, which mean that they thrive in presence of zero oxygen, so that is why the periodontal pockets make a nice environment for them. According to Shweta, & Prakash, the streptococci species, Fusobacterium species, and the black-pigmented anaerobes such as Prevotella and Porphyromonas species are the commonly detected pathogens (Shweta, & Prakash, 2013, p586). Periodontal abscesses can either be chronic or acute and can form as one single abscess or in multiple areas at once. Multiple periodontal abscesses are seen typically in patients with uncontrolled periodontitis and or other systemic diseases that suppress immune systems. Periodontal abscesses can also develop in people without periodontitis who have impacted foreign bodies or other incidences causing trauma to the periodontium (Karnik & Baburaj, 2015, p.25).
Periodontal abscesses make up about 8-14% of all dental emergencies in the United States, making it around the third most common emergency in dentistry (Karnik & Baburaj, 2015, p.24). The reason is, because they present themselves with a variety of signs and symptoms and most of them can be very painful and uncomfortable. The ways these abscesses present themselves is localized swelling of the gums that are usually red in color due to inflammation. The area is also sensitive and can be painful to touch, but also presents a constant throbbing ache. The infected tooth is sensitive during mastication and when cold or hot stimuli come in contact. There is going to be a presence of exudate that may or may not release. In cases of discharge the pus will cause a foul taste for the patient accompanied by halitosis. The build up of exudate is due to the host’s immune response to the bacteria infecting the tissues and is caused by expired white blood cells that were hard at work fighting against the unwanted infection (Ovard, 2013). In severe incidence the tooth may have increased mobility. When the abscess and infection continue on for a long periods of time it can also lead to fever, earaches, a general feeling of malaise, and swelling of the face. If dental abscess are left alone it can lead to even greater infections spreading to near by areas of the neck, jaw, and even the brain. The development of sepsis throughout the body is also a possibility and can be a deadly. Due to the signs and symptoms of periodontal abscess it is no surprise that they lead to an urgent need to seek dental care.
If there is a sign of a dental abscess of any kind it is important to seek medical attention. Sometimes periodontal abscesses will erupt and drain unaided and the painful symptoms subside, however, it is still very important to schedule a visit with a dentist for treatment. During the dental visit the professional must diagnose correctly before they can begin with the proper treatment needed. “The diagnosis of a periodontal abscess should be based on the overall evaluation and interpretation of the patient′s symptomatology, together with the clinical and radiological signs found during the oral examination” (Herrera et al., 2014, p.153). First order of business is the oral examination where the dentist is looking to see if there is any swollen elevated tissue in the gingiva that could represent the accumulation of exudate and possibly suppuration when applying pressure around the infection site. Next, radiographs really aid in the help of diagnosing an abscess because it can provide a view that cannot be seen clinically. It is important to use radiographs to diagnosis periodontal abscesses because other oral disorders can sometimes show similar signs and symptoms. Other tests may be performed as well, such as hot and cold test and percussion tests to locate the exact location of the infection (Ovard, 2013). Once the diagnosis is confirmed the dentist may choose to treat the infection alone or recommend the patient to see a periodontist or endodontist. The goal is to rid the infection along with conserving the teeth and other areas of the periodontium without complications. First step of treatment is to drain the abscess to eliminate the pus and pressure that inflicts most of the discomfort for the patient. This is done by making an incision on the gingiva, going through the periodontal pocket, or making a hole through the tooth. Then it is determined if the abscess should be further treated by extraction of the tooth, surgery, systemic antibiotics, or local antimicrobials (Herrera et al., 2014, p.154). When systemic antibiotics are chosen they are usually some of the most common medications such as penicillin, amoxicillin, or erythromycin. A fairly new treatment approach to abscesses is biofilm decontamination, which is similar to the use of local antimicrobials. Biofilm decontamination aims to eradicate the bacteria in the biofilms around the periodontal pockets destroying more than just the planktonic organisms and breaking through the protective layers of the biofilms. During biofilm decontamination a sulfuric acid solution is used such as Hybend or Epien. The solutions are placed in the infected pocket with a blunt tipped cannula on a syringe for about 30 seconds and removed with water. This effectively works because the sulfuric acid immediately dehydrates and coagulates the biofilms causing death of the bacteria (Pini-Prato, Magnani, & Rotundo, 2016, p.62). There are many other ways to treat periodontal abscess, but the ones mentioned above are some of the most popular. After the treatment of the abscesses, it is important to take care of the oral cavity to prevent future infections. It is important to see a dental hygienist so they can perform scaling and root planing to clean out the periodontal pockets regularly. Also, at home it is important to maintain a good hygiene routine such as brushing a flossing, avoiding foods and drinks that can lead to build up of biofilms, and avoiding injuries that can involve trauma.
It is no surprise that periodontal abscesses are so common in dentistry. That is because millions of people suffer from periodontal disease that puts them at risk, but also for those healthy individuals who develop them through inevitable accidents causing trauma. It is important for dental professionals to know what periodontal abscesses are, why they are caused, what to look for in signs and symptoms, and how to treat and prevent them so they can provide the best possible patient care. It is also important for patients to know about dental abscesses so that they can seek professional treatment to avoid detrimental health issues.