Periodontal abscess

A periodontal abscess most often occurs in patients with pre-existing periodontal disease or in those who are immunocompromised (eg patients with poorly controlled diabetes). Symptoms include swelling of the gums and discomfort. Pain is often difficult to localise, and is not severe enough to interfere with sleep.

It is important to differentiate a periodontal abscess from a periapical abscess, because a periodontal abscess requires local periodontal treatment. Anatomical location of localised odontogenic infections and associated conditions shows the locations of periodontal and periapical abscesses. For the management of periapical abscess, see Localised odontogenic infections.

Management of periodontal abscess includes:

• draining the abscess (with local anaesthetics) through the periodontal pocket beneath the swelling or, less commonly, through an incision in the external surface of the gingival swelling
• removing plaque and calculus deposits with thorough debridement
• irrigating the area with water, saline solution or local anaesthetic solution.

In severe cases, tooth extraction may be necessary to drain pus adequately, followed by thorough irrigation and curettage of the socket.

Specialist management is required if a periodontal abscess does not respond to local intervention.

If the patient is profoundly immunocompromised, treat as for spreading odontogenic infections without severe or systemic features.

In the rare event that a periodontal abscess has spread into surrounding tissues or caused systemic signs and symptoms of infection, it should be treated as an odontogenic infection.