Periodontal Abscess – Causes, Symptoms and Treatment

A periodontal abscess is a collection of pus that can occur in the gums. It generally occurs in those affected by chronic periodontal disease (in the vast majority of cases). It is termed ‘gingival abscess’ if only the gums are affected.

Let’s look at some of the key points about this problem.


What causes this condition?

The primary causative factor is certain bacteria. When conditions are right, bacteria can rapidly multiply in the space between the tooth and gum. If allowed to spread faster than the immune system can counteract it, then the bacteria may cause an abscess.

Such ideal conditions for bacterial growth are found when there is a periodontal pocket (see graphic below). When gums are healthy, they tightly adhere to the teeth. When gum disease develops, they detach gradually, leading to a space between them and the tooth. A pocket is another word for this space.

The pocket is hard to clean and as such plaque, tartar and food debris may collect. This leads to an ideal environment for pus to accumulate.


Graphic showing the causes of a dental abscess

A periodontal pocket with an abscess is labelled number 2 in the graphic. Label 1 refers to a periapical abscess.

The causes of periodontal disease (which can lead to abscesses) include:

  • Poor oral hygiene and neglect of one’s teeth
  • Smoking cigarettes
  • Some medical conditions such as uncontrolled diabetes

People with reduced immune function, due to some diseases or medications for example, are at an increased risk of abscesses in general.


What symptoms may occur?

The most common of the periodontal abscess symptoms is a swelling in the gum. Any swelling can vary greatly in size, and may arise quite quickly. It will have a red, often shiny appearance and may have a white ‘head’. This swelling will be very tender to touch. Pain, which may be severe, usually accompanies an acute flare-up.Image of a woman suffering with toothache

Other symptoms that may occur include:

  • Bad breath from, and taste in, your mouth
  • Bleeding from the area
  • The affected tooth or teeth may become noticeably looser and may drift slightly, leading to spacing between the teeth.
  • The tooth may be shed in cases of very severe periodontal disease.


Acute vs chronic periodontal infections

These are the two main categories of infection, and are categorised depending on the time they have been present. Here are the main differences:

An acute lateral periodontal abscess will arise quite quickly and is generally more severe in terms of the symptoms that occur.

A chronic abscess is one that has been present for some time. Generally speaking, these infections are ‘draining’. This means that the pus is slowly shed via the gum or a hole in the gum (a sinus). As the pus does not build up at the same rate, the infection is not as symptomatic. It may mimic a periodontal cyst.


Periodontal Abscess Treatment

If you have any of the above symptoms, particularly if a swelling is spreading quickly (cellulitis), then seek immediate advice from your dentist. Close-up of woman with open mouth being examined by hygienistAny treatment will vary depending on how severe the dental abscess is. Here are the general steps taken:

  1. Drainage of the pus, via the gum (usually) or an incision in the swelling
  2. Antibiotics may be needed
  3. Deep cleaning of the area to clear any tartar and plaque and help the gum heal
  4. Periodontal surgery may be needed
  5. Root canal may be needed in the case of a ‘perio-endo’ lesion. Here both the pulp and periodontal tissues are infected
  6. Where extraction of the affected tooth is the only option this will be carried out.

It is best to get treatment early, not only for health reasons (as abscesses can be dangerous), but also for a better prognosis. A periodontal abscess can quickly destroy the gum tissues that hold a tooth in place. If left to fester, then the outlook for the tooth can be very poor.


Further reading:

For more info on periodontal disease treatment click here.

Or read this more general article on tooth abscess.

Pericoronitis – from impacted wisdom teeth.

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