Periodontal Abscess – Treatment, Antibiotics, Drainage, Home Remedy, Radiograph

Key Facts

A periodontal abscess is an acute bacterial infection localized within the supporting structures of a tooth

It differs from a periapical abscess, which is located at the apex (tip) of a tooth’s root

Common symptoms include pain, swelling, redness, and a bad taste in the mouth

Treatment involves drainage of the abscess, antibiotic therapy (when required), and addressing the underlying cause

Left untreated, a periodontal abscess can lead to more serious complications, including the spread of infection and potential tooth loss

What is a Periodontal Abscess?

A periodontal abscess, often simply referred to as a gum abscess, is a localized pocket of pus caused by a bacterial infection in the periodontal tissues. These tissues include the gum and bone that surround and support the teeth.

Factors that can contribute to the development of a periodontal abscess:

Pre-existing gum disease (periodontitis): This is the most common cause, where bacterial plaque accumulates and progresses below the gum line, leading to inflammation and eventual abscess formation.
Foreign body impact: An object (like a popcorn kernel) getting stuck between the gum and tooth can cause irritation and potentially lead to an abscess.
Previous dental work: Sometimes, dental procedures can inadvertently introduce bacteria into the gum tissue, leading to abscess formation.
Trauma: An injury to the mouth can lead to an abscess if it results in tissue damage and subsequent infection.

Common symptoms of a periodontal abscess include pain (often sharp and throbbing), swelling and redness in the affected area, a bad taste or odor in the mouth, sensitivity to temperature, and sometimes fever.

Periodontal Abscess vs. Periapical Abscess: What’s the Difference?

While both types of abscesses involve pus and inflammation due to a bacterial infection, their locations and causes are distinct:

Location

Periodontal Abscess: This abscess is located within the gum tissues that support the tooth. It usually arises from the side of the tooth and might present as a swollen, red bump on the gums.
Periapical Abscess: This abscess is situated at the apex or tip of a tooth’s root. It typically arises from a dead or dying tooth pulp, usually as a result of untreated dental decay or trauma to the tooth.

Cause

Periodontal Abscess: As mentioned, this can be due to periodontitis, foreign body reactions, dental work, or trauma. It’s an infection of the space between the tooth and gum.
Periapical Abscess: This arises due to an infection inside the tooth, usually from untreated dental caries (cavities) that progress to involve the tooth pulp.

Radiographic Appearance

Periodontal Abscess: On a dental X-ray, a periodontal abscess may appear as a radiolucency (dark area) in the supporting bone around the tooth’s roots.
Periapical Abscess: On an X-ray, it shows as a radiolucency at the tip of the tooth’s root.

Both abscess types require prompt attention and treatment. Left untreated, the infection can spread, leading to more serious health complications.

What Does a Periodontal Abscess Look Like?

A periodontal abscess typically appears as a localized swelling on the gum.
The affected area often presents with the following characteristics:

Redness: The tissue surrounding the abscess usually appears redder than the adjacent healthy gum tissue.
Swelling: A raised bump or swollen area can often be felt on the gum, indicating the presence of pus beneath the surface.
Pus: In some cases, pus may be visible at the site of the abscess or may ooze out when the area is pressed or spontaneously.
Draining Fistula: In certain instances, an abscess may have a small opening or channel, known as a fistula or sinus tract, through which pus can drain. This might appear as a tiny hole or pimple-like bump on the gum.

Symptoms of a Gum Abscess

A gum or periodontal abscess can be acutely painful, but it’s essential to remember that symptoms can vary from person to person. Common symptoms include:

Pain: The most prominent symptom of an abscess is pain. This can range from a dull ache to sharp, throbbing pain. The pain can also radiate to the ear, jaw, or neck.
Swelling: As mentioned, swelling is a common characteristic of an abscess. The swelling can be confined to the gum or can also affect the face, especially if the infection spreads.
Redness: The gum over the abscessed area will typically appear redder than the surrounding tissues.
Bad Taste or Odor: Due to the presence of pus, individuals with a periodontal abscess may experience a foul taste in their mouth or bad breath.
Sensitivity: The affected tooth and surrounding area might be sensitive to hot, cold, or pressure.
Fever: Some individuals may develop a fever, signaling that the body is fighting off an infection.
Lymph Node Enlargement: In certain cases, the lymph nodes under the jaw or in the neck may become enlarged and tender as the body responds to the infection.
General Malaise: A person might feel generally unwell or fatigued, particularly if the abscess is large or if the infection is spreading.

What Causes a Gum Abscess?

A gum or periodontal abscess is primarily caused by bacterial infection.
The chain of events leading to the formation of an abscess typically unfolds as follows:

Bacterial Accumulation: Dental plaque, a soft, sticky film consisting primarily of bacteria, accumulates on the surfaces of teeth. If not effectively removed through regular brushing and flossing, these bacteria can lead to gum inflammation, known as gingivitis.
Deepening of Gum Pockets: If gingivitis progresses, the gums can pull away from the teeth, creating pockets. These pockets can trap more plaque and bacteria, which can progress into a more severe form of gum disease called periodontitis.
Infection in the Pockets: When bacteria thrive within these pockets, they can lead to the formation of an abscess.
Foreign Body Impact: Sometimes, the presence of a foreign body, such as a piece of food, can get trapped between the tooth and gum, causing irritation and possibly leading to an abscess.
Previous Dental Work: In rare cases, dental procedures might inadvertently introduce bacteria into the gum tissue, causing an abscess.
Trauma: An injury to the gum, whether due to a blunt force or sharp object, can lead to tissue damage and subsequent bacterial infection, which can then manifest as an abscess.

Risk Factors for a Gum Abscess

Several factors can increase the risk of developing a periodontal abscess:

Poor Oral Hygiene: Inadequate or infrequent brushing and flossing can allow for the accumulation of bacterial plaque, setting the stage for gum disease and abscesses.
Tobacco Use: Smoking or chewing tobacco can reduce blood flow to the gums, impairing their ability to heal and fight off infections.
Pre-existing Dental Conditions: Having conditions like untreated cavities or gum disease increases the risk of an abscess.
Immune System Suppression: Individuals with compromised immune systems, whether due to conditions like diabetes, certain medications, or diseases like HIV/AIDS, are more susceptible to infections, including dental abscesses.
Dry Mouth: A decrease in saliva, due to conditions like Sjogren’s syndrome or certain medications, can make the mouth more vulnerable to bacterial growth and gum disease.
Dental Appliances: Ill-fitting dental appliances, such as dentures or braces, can irritate gum tissues and may increase the risk of an abscess.
Previous History: If you’ve had a dental abscess in the past, you’re at a slightly increased risk of developing another.
Nutritional Deficiencies: A lack of essential nutrients, particularly vitamin C, can compromise gum health.

Complications of a Periodontal Abscess

While a periodontal abscess may start as a localized issue, if left untreated, it can lead to more serious complications:

Tooth Loss: The infection can damage the supporting structures of the tooth, leading to increased tooth mobility and, eventually, tooth loss.
Spread of Infection: The bacteria causing the abscess can spread to adjacent tissues, leading to additional oral health complications. In rare cases, the infection can also spread to other parts of the body, such as the sinuses, jaw bone, or even the bloodstream, resulting in a condition called septicemia or sepsis, which is life-threatening.
Dental Cysts: An untreated abscess may lead to the formation of dental cysts, which are sacs filled with fluid or semi-fluid material. These cysts can potentially damage the bones and other structures in the mouth.
Abscess Recurrence: Even after treatment, if the underlying cause isn’t addressed or if oral hygiene isn’t maintained, there’s a risk that the abscess could recur.
Loss of Supporting Bone: Chronic abscesses can lead to the loss of the bone that supports the tooth.

Diagnosis of a Periodontal Abscess

The diagnosis of a periodontal abscess involves a combination of clinical examination and diagnostic tests:

Clinical Examination: Your dentist will begin by asking about your symptoms and medical history. This will be followed by a thorough examination of your mouth. The dentist will be looking for signs of swelling, redness, and drainage points, and might apply pressure to check for pain or pus discharge.
Probing: The dentist may use a tool called a periodontal probe to measure the depth of the gum pockets around the affected area. Deep pockets can be indicative of periodontal disease and potential abscess formation.
X-Rays: Dental X-rays can help identify the extent of the infection, bone loss, and determine whether the abscess is affecting the tooth root or the surrounding bone.
Other Tests: In rare cases, especially if the dentist suspects that the infection might have spread or if there are other complications, additional tests might be recommended.
Differential Diagnosis: It’s essential to distinguish between a periodontal abscess and other types of dental abscesses, such as periapical abscesses, as the origin and treatment might differ. The dentist will use the combination of clinical findings and X-rays to make this distinction.

Once a periodontal abscess is diagnosed, prompt treatment is crucial to prevent complications and preserve oral health.

Treatment: How is a Periodontal Abscess Treated?

The primary aim in treating a periodontal abscess is to drain the pus and eliminate the infection. Treatment approaches include:

Draining the Abscess: The dentist may make a small incision to allow the pus to drain out. After draining, the area is thoroughly cleaned.
Scaling and Root Planing: This is a deep cleaning procedure to remove plaque and tartar from the gum pockets and smooth the root surfaces. This helps in preventing further bacterial colonization.
Antibiotics: If the infection is severe or has spread, or if the patient has a compromised immune system, antibiotics may be prescribed.
Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be used to manage pain. Always consult with your dentist or doctor before taking any medication.
Tooth Extraction: In extreme cases where the tooth or surrounding structures are severely damaged, it may be necessary to remove the tooth.
Follow-up: A follow-up visit ensures the infection is cleared and there are no lingering issues.

How Can I Lower My Risk for Periodontal Abscesses?

Reducing the risk of a periodontal abscess primarily involves maintaining good oral hygiene and regular dental check-ups:

Regular Brushing and Flossing: Brush at least twice a day and floss daily to remove dental plaque.
Professional Cleanings: Have your teeth professionally cleaned every six months or as recommended by your dentist.
Avoid Smoking: Tobacco can decrease your ability to fight off infections and slow the healing process.
Balanced Diet: Eating a balanced diet ensures you get all the necessary nutrients for healthy gums and teeth.
Dental Check-ups: Regular check-ups can detect early signs of gum disease, which can be treated before an abscess forms.

Will a Periodontal Abscess Go Away?

A periodontal abscess will not typically go away on its own. While the pain might temporarily subside, the infection can remain and even spread, leading to more severe complications. It is crucial not to ignore the symptoms of an abscess and to seek dental care promptly. Left untreated, the infection can damage surrounding tissues and even become life-threatening if it spreads to other parts of the body.

How Urgent is a Periodontal Abscess?

A periodontal abscess is a dental emergency. The condition signifies an active infection, and if not treated promptly, it can lead to more severe complications, including the spread of infection to other parts of the body.

When Should I See My Healthcare Provider?

If you suspect you have a periodontal abscess, you should:

Seek Immediate Dental Care: Ideally, you should see a dentist as soon as you recognize the signs of an abscess. This is the best approach since dentists are specifically trained to handle such issues.
Signs and Symptoms: Swelling, pain, pus discharge, a foul taste in the mouth, or elevated body temperature are common indicators of an abscess and warrant an immediate dental visit.

When Should I Go to the Emergency Room?

While a dentist is the preferred professional to address a periodontal abscess, there are situations where an ER visit might be necessary:

Severe Swelling: If the swelling spreads to other parts of your face, neck, or eyes, or causes difficulty breathing or swallowing.
High Fever: A fever can indicate that the infection is spreading or becoming systemic.
Inability to Reach a Dentist: If you can’t get a dental appointment quickly and your symptoms are worsening, it’s essential to get care at an emergency room.
General Feelings of Unwell: If along with the dental symptoms, you feel generally unwell, lethargic, or extremely fatigued, this could signify a more serious infection that needs immediate attention.

What Questions Should I Ask My Healthcare Provider?

When discussing a periodontal abscess with your healthcare provider or dentist, consider asking the following questions:

What’s the extent of the infection?
Is there any damage to the surrounding bone or tissue?
What treatment options are available for my condition?
Will I need antibiotics, and if so, what potential side effects should I be aware of?
How can I manage pain or discomfort related to the abscess?
Are there any potential complications I should be aware of?
What oral care regimen should I follow post-treatment to ensure complete recovery?
How can I prevent a recurrence of a periodontal abscess?
Should I make any changes to my oral hygiene routine?
When should I follow up after the treatment?

Being proactive and informed about your dental health is crucial. Always seek professional advice if you suspect you have a dental or medical issue.

Is a Periodontal Abscess Contagious?

While a periodontal abscess itself is not contagious, the bacteria causing the abscess can spread through saliva. It’s essential to avoid sharing utensils, drinks, or engaging in activities that can transfer saliva, like kissing, when you have an oral abscess. However, just being near someone with a periodontal abscess or talking to them does not pose a risk of transmission.

Can I Pop a Periodontal Abscess?

It is highly discouraged to try and pop a periodontal abscess yourself. Puncturing an abscess can push the infection deeper into tissues and spread it. Additionally, there’s a risk of introducing new bacteria into the abscess or injuring yourself. If an abscess breaks on its own, it’s essential to keep the area clean and seek dental care immediately.

Home Remedy: Can I Treat a Periodontal Abscess at Home?

While there are home remedies that might alleviate some of the discomfort associated with a periodontal abscess, they are not treatments or cures. They can include:

Warm Saltwater Rinse: This can help in reducing pain and inflammation.
Over-the-counter Pain Relievers: Always consult with a healthcare provider before taking any medication.
Cold Compress: Applying a cold pack outside the cheek for 15 minutes can help reduce pain and swelling.

Remember – these are only temporary relief methods. A periodontal abscess requires professional dental treatment to address the root cause of the infection and prevent complications.

Periodontal Abscess ICD-10 Code

The International Classification of Diseases, Tenth Revision (ICD-10) is a system used worldwide to classify and code all diagnoses, symptoms, and procedures.
For a periodontal abscess, the ICD-10 code is: K05.21 – Periodontal abscess with sinus.

Bottom Line

A periodontal abscess is an inflammatory response to a bacterial infection within the supporting structures of a tooth. While it shares similarities with a periapical abscess, understanding the differences between the two is crucial for accurate diagnosis and appropriate treatment. A periodontal abscess is a serious dental condition that necessitates prompt professional intervention. While it is caused by bacteria, the abscess itself isn’t contagious, but precautions should be taken. Home remedies can offer temporary relief, but they are not a substitute for professional care. Never try to puncture or pop an abscess on your own. If you suspect you have an abscess or any dental concern, always consult with a dental professional promptly.

This article is complete and was published on October 20, 2023, and last updated on October 20, 2023.

Key Facts