abscesses effecting the periodontium associated with tooth loss

1. PERIODONTAL ABSCESS
1
Presented by
Dr. Guru Ram Tej K
II yr Post Graduate

2. CONTENTS
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INTRODUCTION
DEFINITION AND PREVALENCE
CLASSIFICATION
ETIOLOGY OF PERIODONTAL ABSCESS
MICROBIOLOGY
PATHOGENESIS AND HISTOPATHOLOGY
CLINICAL FEATURES
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT OF PERIODONTAL ABSCESS
CONCLUSION
REFERENCES
2

3. INTRODUCTION
3

4. DEFINITION

International conference on research in biology of
periodontal disease 1977

Carranza 1990

Hafstrom 1994
4

5. PREVALENCE
3rd most frequent dental emergency
 Representing 7-14%
 Affecting 6-7%

Effects prognosis of tooth
 Gray et al 1994- 27.5% and 59.5%
 Mc Leod et al 1997- 37%
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5

6. CLASSIFICATION
Based on duration
 Based on number
 Based on location
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Based on etiology
 Periodontitis related
 Non- periodontitis related
6

7. PERIODONTITIS RELATED ABSCESS
Active periodontal destruction
 Exacerbation of a chronic lesion
 Post therapy periodontal abscess
 Post scaling
 Post surgery
 Post antibiotic(Topoll in 1990)
(Helevou et al in 1993-broad spectrum
antibiotics)
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7

8. 
Four types of abscess associated with periodontal
tissues
 Gingival abscess
 Peri-coronal abscess
 Combined periodontal/ endodontic
 Lateral Periodontal abscess
8
{Periodontal abscess: A review Punit Vaibhav Patel, Sheela Kumar G, Amrita Patel}

9. NON PERIODONTITIS RELATED ABSCESS
Impaction of foreign body
 Orthodontic devices
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Root morphology alterations
 Invaginated root(Chen et al in 1990)
 Fissured root(Goose 1981)
 Root tears(Haney et al 1992)
 Endodontic perforations(Abrams et al 1992)
9

10. ETIOLOGY OF PERIODONTAL ABSCESS
Etiology
Environmental
factors
Microbiological
factors
Other local
factors
10

11. ENVIRONMENTAL FACTORS
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Pocket
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Pre existing pocket
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Major factor
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Deeper, narrower, tortuous
11

12. MICROBIOLOGY
Anaerobes (Newman& Sims)
 P. gingivalis- 50-100%(Topoll et al in 1990)
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F nucleatum
B forsythus
P gingivalis
P intermedia
Periodontal pathogens usually isolated
from periodontal abscess
12

13. Herrera et al in 2000- 45% anaerobes resembles
periodontitis microbiota
 Polymicrobial, non motile, gram negative, rod
shaped anaerobes
 Ashimoto et al- P gingivalis
Other microbes include
 P intermedia
 P melaninogenica
 F nucleatum
 B forsythus
 Spirochetes
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13

14. VIRUSES IN PERIODONTAL ABSCESS
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Saygun et al in 2004- CMV and EBV1
14

15. OTHER LOCAL FACTORS
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Foreign material such as
1. Pop-corn husk
2. Impacted food
3. Fish bone
4. Tooth brush bristles
5. Irrigating devices
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ANACHORETIC EFFECT
15

16. DIABETES AND PERIODONTAL ABSCESS

Low host resistance
 Decreased chemotaxis/ phagocytosis
 Altered collagen metabolim
16

17. PATHOGENESIS
Entry of bacteria into
soft tissue wall
Trauma to the orifice of the
periodontal pocket
Formation of infiltrate
Destruction of connective tissues
Pus formation
Decreased tissue
resistance
Virulence and
number of bacteria
17

18. HISTOPATHOLOGY

De Witt et al in 1985
18

19. CLINICAL FEATURES AND DIAGNOSIS
Acute Abscess
 Localized red, ovoid swelling
 Periodontal pocket
 Mobility
 Tooth elevation in socket
 Tenderness to percussion or biting
 Exudation
 Elevated temperature
 Regional lymphadenopathy (Smith and Davies „86)
19

20. Chronic Abscess
 No pain or dull pain
 Localized inflammatory lesion
 Slight tooth elevation
 Intermittent exudation
 Fistulous tract often associated with a deep pocket
 Usually without systemic involvement
20

21. 
Herrera et al in 2000- blood and urine samples-
reported 30%- elevated leukocytes
and 20-40% neutrophils and monocytes
21

22. DIFFERENTIAL DIAGNOSIS

Peri apical abscess
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Manifestation of systemic disease
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Incomplete tooth fracture
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Pericoronitis

Periodontal cysts
22

23. MANAGEMENT OF PERIODONTAL
ABSCESS
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The treatment of the periodontal abscess usually
includes two stages:
(1) The management of the acute lesion, and
(2) The appropriate treatment of the original and/or
residual lesion, once the emergency situation has been
controlled
23

24. THE MANAGEMENT OF THE ACUTE LESION
Draining the abscess
with digital pressure
Incision and drainage
(Ahl et al 1986)
Scaling and root planing
24

25. THE APPROPRIATE TREATMENT OF THE
ORIGINAL AND/OR RESIDUAL LESION
Periodontal surgery
The use of different systemically administered
antibiotics, and
Tooth extraction.
25

26. ANTIBIOTICS
Antibiotic Options for Periodontal Infections1
Antibiotic of Choice
 Amoxicillin, 500 mg
 1.0-g loading dose, then 500 mg tid, 3 days
Penicillin Allergy
 Clindamycin 600-mg loading dose, then 300 mg
qid, 3 days
 Azithromycin (or clarithromycin)
 1.0-g loading dose, then 500 mg qid, 3 days
26

27. 
Smith and Davies in 1986- metranidazole (200mg tid
5days)

Herrera et al in 1994- tetracycline therapy

There was a rapid control of pain levels, reduction in
edema, redness and swelling, periodontal probing depth
were significantly reduced.

Gingivectomy
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Surgical flaps
27

28. CLENCHING
ABSCESS
28
CASE REPORT BY KRITHIKA ET AL IN 2011

29. RECENT STUDIES
If untreated the periodontal abscess may lead to
cervicofacial necrotizing fasciitis
Medeiros et al 2012
 Orthodontic Elastic Separator-Induced periodontal
Abscess: A Case Report

29
Talia Becker and Alex Neronov in 2012

30. CONCLUSION
30

31. REFERENCES
Newman, Takei, Klokkevld, Carranza,; Carranza‟s clinical
periodontology. 10th Ed. 714
 Jan Lindhe, Niklaus P Lang, T Karring; Clinical
periodontology and implant dentistry 5th ed
 “Periodontal Abscess”- A Review - (2000) Herrera.
D, Journal of Clinical Periodontology: 27; 377-387.
 “Periodontal Abscess” etiology and classification-(1999)Meng H. - Annals of Periodontology;79-82
 “Predominant Cultivable Microbiota”- Newman et
al.(1979).Journal of Periodontology;27;350-354
 Ashimoto. PCR detection of Periodontal/ endodontal
pathogens associated with abscess formation (1998) - 31
Journal of Dental Research 77; 854-858.
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32. 
Topoll HH, Lange DE and Miller RF: Multiple periodontal abscesses after
systemic antibiotic therapy. J Clin Periodontol 1990; 17: 268-272.

Krithiga Gurumoorthy, Babitha Ajjappa, Shobha Prakash; multiple acute
periodontal abscesses due to clenching.: Journal of Interdisciplinary
Dentistry / Jan-Jun 2011 / Vol-1 / Issue-1

Saygun I, Yapar M, ozdemir A, Kubar A, Slots J. Human cytomegalo virus
and Ebstien Barr virus type 1 in periodontal abscesses: oral microbiol
Immunol 2004: 19: 83-87

Cervicofacial necrotizing fasciitis following periodontal abscess. Medeiros
Junior, Rui De Sousa Catunda, IvsonVieira Queiroz, Isaac Henrique Araujo
de Morais, Hecio Carneiro Leao, Jair Alcino Monteiro Gueiros, Luiz: general
dentistry jul/aug 2012. Vol 60 issue 4, 316-321

Norhidayah, Khamiza What Expert Says … Periodontal Abscess Malaysian
Dental Journal (2008) 29(2) 154-157

Obradović R. Radmila, Kojović B. Draginja, Branković R. Vesna: The
Therapy Of Periodontal Abscess: Acta Stomatologica Naissi, Jun/June
2008, Vol. 24, Broj/Number 57.

Talia Becker and Alex Neronov: Orthodontic Elastic Separator-Induced
Periodontal Abscess: A Case Report; case reports in dentistry 2012
32

33. Thank you…