Periodontal abscess - inflammation of the periodontal tissues

Gingivitis, periodontitis, periodontal disease, poor-quality fillings and incorrect prosthetics of elements of the dental system often lead to acute purulent focal inflammation. Pathology can be expressed in swelling of the mucous membrane, mobility of molars, enlarged lymph nodes, acute pain when chewing food. For periodontal abscess

There may be damage to the periosteum with the vestibular or lingual surface. The presented clinical picture often occurs as a result of mechanical, physical, and thermal trauma to the gums. Provoking factors may be the entry of a foreign body into the gum pocket.

Periodontal abscess of a tooth is a lesion of the soft tissues of an element of the dentition, which is accompanied by the accumulation of purulent exudate. As the pathology develops, a fistula tract may open. When you press on the gums or eat hot or cold food, a sharp, throbbing pain appears. An element of the dental system may sway without any apparent reason. Gradually, the tumor grows, which ultimately leads to swelling in the cheek area. The cause of the disease is harmful bacteria that cause acute inflammation. Therapy in this case is aimed at preventing complications, resolving purulent inflammation and remission.

What is a gum abscess, definition of the disease

Let us consider in more detail what an abscess on the gum is and the mechanism of its occurrence. A purulent focus occurs as a result of long-term untreated inflammation of periodontal tissues. The pathogenesis of the disease is associated with the penetration of pathogenic microorganisms (mainly Bacteroides forsythus and Porphyromonas gingivalis) into the periodontal tissues. Possible routes of penetration of microbes:

• from the outside: through a carious cavity, chips, cracks on the surface of the segment;
• from the inside (hematogenously, lymphogenously): in the presence of other septic foci in the body.

During their life, bacteria produce toxic substances that lyse tissue cells, resulting in the formation of a cavity filled with pus. The abscess under the tooth is surrounded by a connective tissue capsule, which separates it from the intact periodontal tissues.

Microbial metabolic products have a neurotoxic effect on nerve receptors located in the pulp of the segment, which causes pain. In addition, they increase the permeability of the capillary walls, resulting in swelling of the surrounding tissues.

Causes of gum abscess

The human oral cavity contains about 30 strains of microorganisms, represented by more than 700 species of bacteria. Under normal conditions, microbiocenosis does not harm its owner. A dental abscess occurs only in the presence of certain factors:

• traumatic disruption of the periodontal junction;
• infectious dentogingival pathologies;
• transmission of microorganisms through the bloodstream from other infectious foci (meningitis, pneumonia, tonsillitis, etc.);
• gum damage during segment therapy;
• trauma to the crown or root of the unit;
• peri-implantitis (inflammation around the implanted tooth root).

The likelihood of developing the disease increases with poor oral care, hypothermia, accumulation of tartar inside deep periodontal pockets, and smoking. Professional hygiene and gum treatment in Moscow is carried out by doctors of the North-Eastern Dental Center No. 1. A timely visit to the clinic will reduce the risk of the formation of a purulent formation.

Symptoms of gum abscess

Gingival abscess manifests itself in two types of symptoms: local and general clinical. Local symptoms are caused by reactive manifestations in the area of ​​inflammation. The appearance of general symptoms is associated with intoxication of the body. The main symptomatic manifestations of the disease:

The leading symptom of an abscess is pain. It can be fixed only at the point of inflammation, but more often the discomfort radiates to the head, auricle, eye socket, neck, and neighboring segments. Soreness has different intensity, character (sharp, shooting, dull), occurs periodically in response to stress factors, or is constantly present.

How a surgical autopsy is performed

Surgical opening (periostomy) can be complicated by the general condition of the patient and the size of the tumor. In some cases, it reaches such a size that it requires the installation of a drainage, a small tube that facilitates the outflow of purulent contents from the pocket. After opening such tumors, due to long-term suppression of the immune system, the patient is prescribed not only antibacterial drugs, but also immunostimulating therapy.

To avoid complications after surgery, dentists recommend their patients:

• refrain from smoking, drinking alcohol, and excessive food consumption;
• do not abuse sleeping pills and laxatives;
• do not take strong painkillers unless absolutely necessary;
• if the condition worsens, namely an increase in body temperature, the appearance of pus, redness around the incision, increased pain, incl. headache, muscle pain, immediately seek help from a doctor.

Stages of development and classification of gum abscess

A gum abscess most often has an acute course, characterized by a clear clinical picture with increasing pain and swelling. Sometimes, in the absence of treatment, the process may subside, the clinic becomes weakly expressed and erased. This means that the abscess has become chronic.

Depending on the location of the purulent focus, several types of pathology are distinguished:

1. Periodontal abscess. Localized inside the hypertrophied periodontal pocket (between the alveolar process and the gum). The cause of the pathology is subgingival deposits, which are a breeding ground for the proliferation of bacteria.
2. Periapical (root). The leading cause of occurrence is inadequate root canal treatment, leading to periodontal inflammation. Granulations form near the root apex. Progressive inflammation spreads to the periosteum and periodontal tissue. A connective tissue capsule with purulent contents is formed. Over time, a fistula forms with pus coming to the surface in the form of a lump.
3. Desnevoy. The purulent cavity is located near the papillae between the segments. A possible cause is an injection into the gum.

Diagnostics

The examination includes:

• patient interview,
• inspection,
• dental radiography,
• laboratory and instrumental methods.

During the examination, the doctor sees a painful local bulge and altered mucous membrane. There is no transitional fold from the periodontium to the tooth. The depth of the pockets is at least 3 millimeters.

X-ray shows:

• enlargement of the periodontal gap,
• destruction of the cortical plate,
• uneven resorption of spongy substance.

A blood test indicates nonspecific inflammation:

• high level of leukocytes,
• increase in ESR,
• shift of the leukocyte formula to the left.

PCR allows you to accurately determine the composition of the microflora of the gum pockets. With an abscess, the number of bacteria increases 100 times. During the examination, doctors exclude:

• acute periodontitis or exacerbation of the chronic form,
• cyst with suppuration,
• periostitis,
• osteomyelitis.

Stages of development of gum abscess

Diagnosis of the disease

At the initial stage of diagnosis, the dentist-therapist performs a visual examination with palpation of the inflamed area. In order to determine what other structures are affected, X-ray and laboratory examinations are performed. An appropriate examination allows us to establish the localization of the purulent sac; it can be cervical, apical, or hilar. Laboratory analysis helps to identify markers of infection and determine the type of pathogen. Digital X-ray diagnostics allows you to determine whether the inflammatory process has reached the bone tissue, this will help to understand whether surgical treatment is required for periodontal abscess.

In accordance with the data obtained from the anamnesis and x-ray, a cytological examination of the salivary fluid may be required. The latter makes it possible to identify the number of damaged granulocytes. In case of suppuration in the area of ​​the dental system and osteomyelitis, the help of a dental surgeon may be required. In each specific case, consultation with an experienced specialist is necessary in order to establish the clinical picture as accurately as possible and determine a scheme for endodontic treatment or surgical intervention.

Complications that a gum abscess can cause

Without treatment of the disease and inadequate medical care, complications may develop. Adverse consequences arise due to the spread of inflammation to neighboring organs and tissues, as well as the spread of infection throughout the body with the formation of secondary septic foci. The most common pathological conditions that occur are:

• lymphadenitis - infection of the lymph nodes;
• sinusitis - infection in the maxillary sinuses;
• periostitis of the jaw (inflammation of the periosteum);
• osteomyelitis of the jaw bones (destruction of bone tissue due to purulent-necrotic melting of osteocytes);
• phlegmon - diffuse odontogenic inflammation of soft tissues, accompanied by progressive swelling of the face;
• destruction of the alveolar processes with significant loosening of teeth or their loss;
• peri-implantitis with implant rejection;
• sepsis.

Purulent lesions of soft periodontal tissues are always accompanied by general intoxication of the body. The temperature rises and chills appear. There is a headache, tachycardia, and the pulse quickens. Pain relief with medications brings short-term relief, but symptoms return after the medication wears off.

Treatment of gum abscess

Treatment of the disease is aimed at solving two main problems:

An abscess on the gum is a serious dental pathology. If treatment is not started in time, the process continues to develop and leads to adverse consequences. To avoid complications, at the first signs of inflammation you should make an appointment with the dentist. ]dentistry in Otradnoye[/anchor] offers assistance in eliminating problems with diseased teeth and periodontal disease.

First aid

• Before visiting the dentist, you can take painkillers to reduce pain: Paracetamol, Nurofen.
• It is recommended to rinse the mouth with antiseptic solutions: furatsilin, potassium permanganate.
• It is forbidden to squeeze out the abscess, as well as use any thermal procedures in the area of ​​the abscess: compresses, heating pads, as this can lead to the spread of the purulent process.
• In case of intoxication (fever, headache), it is necessary to increase the drinking regime to 2.5–3 liters per day.