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PERIODONTAL ABSCESS

Presented byDr. Guru Ram Tej KII yr Post Graduate

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CONTENTS

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

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INTRODUCTION

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DEFINITION

International conference on research in

biology of periodontal disease 1977

Carranza 1990

Hafstrom 1994

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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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CLASSIFICATION

Based on duration Based on number Based on location

Based on etiology Periodontitis related Non- periodontitis related

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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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Four types of abscess associated with periodontal tissues

Gingival abscess Peri-coronal abscess Combined periodontal/ endodontic Lateral Periodontal abscess

{Periodontal abscess: A review Punit Vaibhav Patel, Sheela Kumar G, Amrita Patel}

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NON PERIODONTITIS RELATED ABSCESS

Impaction of foreign body Orthodontic devices

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)

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ETIOLOGY OF PERIODONTAL ABSCESS

Etiology

Environmental factors

Microbiological factors

Other local factors

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ENVIRONMENTAL FACTORS

Pocket

Pre existing pocket

Major factor

Deeper, narrower, tortuous

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MICROBIOLOGY

Anaerobes (Newman& Sims) P. gingivalis- 50-100%(Topoll et al in 1990)

Periodontal pathogens usually isolated from periodontal abscess

F nucleatumB forsythusP gingivalisP intermedia

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Herrera et al in 2000- 45% anaerobes resembles periodontitis microbiota

Polymicrobial, non motile, gram negative, rod shaped anaerobes

Ashimoto et al- P gingivalisOther microbes include

P intermedia P melaninogenica F nucleatum B forsythus Spirochetes

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VIRUSES IN PERIODONTAL ABSCESS

Saygun et al in 2004- CMV and EBV1

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OTHER LOCAL FACTORS

Foreign material such as1. Pop-corn husk2. Impacted food3. Fish bone4. Tooth brush bristles5. Irrigating devices

ANACHORETIC EFFECT

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DIABETES AND PERIODONTAL ABSCESS

Low host resistance Decreased chemotaxis/ phagocytosis Altered collagen metabolim

PATHOGENESIS

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Trauma to the orifice of the periodontal pocket

Destruction of connective tissues

Formation of infiltrate

Entry of bacteria into soft tissue wall

Decreased tissue resistance

Pus formation

Virulence and number of bacteria

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HISTOPATHOLOGY

De Witt et al in 1985

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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)

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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

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Herrera et al in 2000- blood and urine

samples- reported 30%- elevated leukocytes

and 20-40% neutrophils and monocytes

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DIFFERENTIAL DIAGNOSIS

Peri apical abscess

Manifestation of systemic disease

Incomplete tooth fracture

Pericoronitis

Periodontal cysts

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MANAGEMENT OF PERIODONTAL ABSCESS

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

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Draining the abscess with digital pressure

Incision and drainage (Ahl et al 1986)

Scaling and root planing

THE MANAGEMENT OF THE ACUTE LESION

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THE APPROPRIATE TREATMENT OF THE ORIGINAL AND/OR RESIDUAL LESION

Periodontal surgeryThe use of different systemically administered

antibiotics, and Tooth extraction.

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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

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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

Surgical flaps

28CASE REPORT BY KRITHIKA ET AL IN 2011

CLENCHING ABSCESS

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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

Talia Becker and Alex Neronov in 2012

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CONCLUSION

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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) - Journal of Dental Research 77; 854-858.

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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

Thank you…