Periodontal abscess

Background

Dental Numbering

Classic dental numbering.

• Adult (permanent) teeth identified by numbers
  • From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
• Children (non-permanent) teeth identified by letters
• Common landmarks:
  • 1: Right upper wisdom
  • 8 & 9: Upper incisors
  • 16: Left upper wisdom
  • 17: Left lower wisdom
  • 24 & 25: Lower incisors
  • 32: Right lower wisdom

Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.

• Occurs when plaque and debris become entrapped in periodontal pocket
• Other terms: lateral abscess, parietal abscess

Clinical Features

Periodontal abscess between the lower left canine and first premolar.

• Severe pain
• Sensitivity to palpation
• Suppuration with gentle pressure

Differential diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

Odontogenic Infections

• Acute alveolar osteitis (dry socket)
• Acute necrotizing ulcerative gingivitis (trench mouth)
• Dental abscess
  • Periapical abscess
  • Periodontal abscess
• Ludwig's angina
• Pulpitis (dental caries)
• Pericoronitis
• Peritonsillar abscess (PTA)
• Retropharyngeal abscess
• Vincent's angina - tonsillitis and pharyngitis

Other

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Evaluation

• Usually clinical

Management

• Local therapy for small abscesses
  • Penicillin VK 500 mg PO QID or clindamycin 300 mg PO QID
  • Warm saline rinses
• Larger abscesses require I&D
• Chlorhexidine 0.1% mouth rinses BID for short-term use

Disposition

• Out-patient treatment

See also

Dental problems