Dental Abscess

Dental abscess can be caused by periodontal(gum) disease, damaged (necrotic) nerve, and sometimes by combination of both factors (true combined lesions).

Periodontal Abscess is a localized accumulation of pus within the gingival wall of periodontal pocket (space between a tooth and gum tissue around it).

The accute periodontal abscess appears as an ovoid elevation of the gingiva along the lateral(side) aspect of the root. The gingiva(gum) is edematous(swollen), red with a smooth shiny surface. The shape and consistency of the elevated area vary; it may be dome-like and relatively firm or pointed and soft. In most cases, pus may be expressed from the gingival margin by gentle digital pressure.

The chronic periodontal abscess usually presents a sinus that opens onto gingival mucosa(gum tissue) somewhere along the length of the root. There may be a history of intermittant exudation (pus). The orifice of the sinus may appear as a difficult-to-detect pinpoint opening. The chronic periodontal abscess is usually asymptomatic (no pain). However, the patient may report episodes of dull, gnawing pain; slight elevation of the tooth; and a desire to bite down on and grind the tooth.

Diagnosis of the periodontal abscess requires correlation of the history and clinical and radiographic findings. The suspected area should be probed carefully along the gingival margin in relation to each tooth surface to detect a channel from the marginal area to the deeper periodontal (gum) tissues. Continuity of the lesion with the gingival margin is clinical evidence that the abscess is periodontal.

Acute Apical Abscess is a localized destruction of tissue and is a severe inflammatory response to microbial and/or nonbacterial irritants from a necrotic(non-vital) pulp.

Signs and Symptoms

Depending on the severity of reaction, patients usually have moderate to severe discomfort and/or swelling. In addition, patients occasionally have systemic manifestations of an infective process such as high temperature, malaise. Electrical or thermal stimulation of teeth produces no response. However, these teeth are usually painful to percussionn and palpation.

Depending on the degree of hard tissue destruction inflicted by the irritants, radiographic features can range from thickening of the periodontal ligament around the involved tooth to the presence of a frank periapical lesion.

Treatment

Removal of the underlying cause (necrotic pulp), release of pressure (drainage where possible), followed by a routine root canal therapy resolves most cases.