Periodontal abscess

Introduction to periodontal abscess Periodontal abscess is not an independent disease, but a common concomitant symptom after the development of periodontitis to the advanced stage and deep periodontal pockets. It is a localized suppurative inflammation in the periodontal pocket or deep periodontal tissue that can cause damage to surrounding collagen fibers and bone. According to the abscess site, it is divided into periodontal abscess and hernia abscess. According to the course of the disease, it is divided into acute and chronic periodontal abscess. According to the number, it is divided into single and multiple periodontal abscesses. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: bacteremia

Causes of periodontal abscess

Suppurative inflammation (30%):

The purulent inflammation of the inner wall of the deep periodontal pocket expands to the deep connective tissue, and when the pus cannot be discharged into the bag, the abscess in the soft tissue of the bag wall can be formed; the deep periodontal pocket involving the multiple teeth, the pus Sexual exudates cannot be drained smoothly, especially when the root bifurcation area is involved.

Jiezhi or scaling (25%):

When scaling or scraping, the action is rough, pushing the calculus fragments and bacteria into the deep tissue of the periodontal pocket, or damaging the gum tissue; the cure of the deep periodontal pocket is not complete, resulting in the tightness of the pocket of the periodontal pocket, but The inflammation at the base of the periodontal pocket is still present and no drainage is obtained.

Endodontic treatment (20%):

When the pulp is treated, the root canal or the medullary side of the pulp can be worn, and the root can be split longitudinally, which can sometimes cause periodontal abscess.

Systemic disease (15%):

The body's resistance is reduced or there are serious systemic diseases, such as diabetes, which are prone to periodontal abscess. Patients with multiple or recurrent episodes of periodontal abscess should be aware of the possibility of excluding diabetes.

Microorganisms (5%):

Some highly toxic periodontal pathogenic microorganisms colonize and proliferate in periodontal pockets, causing infection to spread and spread.

Pathological change

There is a large amount of living or necrotic neutral multi-line leukocytic accumulation in the periodontal pocket wall. Necrotic leukocytes release a variety of proteolytic enzymes that cause necrosis and dissolution of surrounding cells and tissues, forming pus, located in the center of the abscess. There is an area of acute inflammation around the abscess, the epithelium on the surface is highly edematous, and a large number of white blood cells enter the epithelium.

Periodontal abscess prevention

(1) Pay attention to oral hygiene

It is a good habit to develop early, late, and post-harvest gargles. By diligently, you can clear the food residue between the teeth and keep the mouth and teeth clean. If gums are found, they should be treated early. If left untreated, bacteria and their toxins can infect the pulp through the dentinal tubules or directly through the medullary canal, causing inflammatory conditions in the apical and periodontal tissues.

(two) protect the teeth

Love the teeth, not to be hurt by the fall, because of sudden external forces such as falls, collisions, etc., added to the teeth, often become the cause of inflammation around the root tip. If you have been hurt by a broken door. Should be treated by an early dentist. It can reduce or eliminate the occurrence of this disease.

(three) caries

In the morning, the molars have the function of healthy teeth. Dental caries can also promote the increase of saliva secretion, assist the digestion of the spleen and stomach, can reduce food stagnation, gastrointestinal heat, can reduce the incidence of this disease.

Periodontal abscess complications Complications bacteremia

1. Tooth loss: Periodontal abscess is closely associated with tooth loss in patients with moderate to severe periodontitis (Chace & Low 1993, McLeod et al. 1997). It is the main reason for tooth extraction during maintenance (Chace & Low 1993). Repeated periodontal abscesses, combined with other manifestations, can be used as a basis for judging the poor prognosis of the teeth (Becker et al. 1984). A retrospective study found that 45% of patients with periodontal abscesses were removed during maintenance (McLeod et al. 1997). Another retrospective study analyzed 455 patients with poor prognosis and found that 55 (12%) had an average retention of 8.8 years, and the main cause of tooth extraction was periodontal abscess (Chace & Low 1993). Tooth extraction is a common method for treating periodontal abscess. Of the 62 periodontal abscesses studied by Smith & Davies (1986), 14 (22.6%) had extraction as the preferred treatment and 9 (14.5%) had extraction after the acute phase. Abscess recurred after treatment in 22 cases, 14 of which were removed in 3 years. There are also doctors who report a surprisingly rapid healing after treatment of periodontal abscesses (Ammons 1996).

2. Infection spread : A large number of case reports describe infections in different parts of the body that may be caused by periodontal abscesses. This may be caused by bacteremia during treatment, or it may be that bacteremia has occurred without treatment of the abscess.

3. Bacteremia after treatment of abscess : Suzuki & Delisle (1984) reported that a patient with periodontal abscess treated with ultrasound was treated with pulmonary actinomycosis after 1 month. The authors believe that treatment has transferred actinomycetes from the underarm flora to the lungs. Gallaguer et al. (1981) reported that a patient with periodontal abscess who did not have systemic antibiotics developed a brain abscess 2 weeks after drainage and died after 1 month. Bacterial culture of brain abscess found melanin-producing bacteria and other bacilli. Therefore, the author believes that scraping causes bacteremia and leads to a fatal brain abscess. A retrospective study of knee arthroplasty infection (Waldman et al. 1997) found that 9 of the 74 infected individuals had been treated for 2 weeks due to oral infections, and bacterial culture also confirmed that the knee infection was from the mouth. One of the nine patients underwent periodontal abscess drainage, although the use of antibiotics throughout the body did not prevent their knee infection. There is still debate about the need for preventive use of antibiotics in these patients. Before the abscess is cut, it is desirable to aspirate the contents of the needle to reduce the risk of bacteremia (Roberts & Sherriff 1990, Flood et al. 1990).

4. Abscess caused by untreated bacteremia: sputum inflammation and periodontal abscess cause temporary bacteremia, which can cause cellulitis in breast cancer patients (Manian 1997), because the defense function of these patients due to radiotherapy and crotch Lymph node resection and damage. The mouth is often the source of infection in the chest and upper limbs (Manian 1997). Periodontal abscesses are associated with necrotizing fasciitis in the neck (Chan & McGurk 1997). Although the disease is rare, it is often associated with oropharyngeal and odontogenic infections. Three related reports showed that necrotizing cavernositis requiring surgery or systemic antibiotics was associated with severe periodontal infection. The culture of cavernous bacteria found Streptococcus pneumoniae and Fusobacterium. Patients with abscess can also develop sexual incompetence (Pearle & Wendel 1993). Periodontal abscess can also cause crisis in patients with sickle cell anemia (Rada et al. 1987). At this time, antibiotics should be used to treat the abscess to relieve pain and prevent infection from spreading. The periodontal system is treated after the crisis is removed.

Periodontal abscess symptoms Common symptoms Gingival long pustules, swollen teeth, loose teeth and detached periodontal pockets

Periodontal abscess is generally an acute process, which can break the pus and resolve itself, but if it is not actively treated, or repeated acute attacks, it can become a chronic periodontal abscess.

The acute periodontal abscess is sudden onset, forming an elliptical or hemispherical swelling protrusion on the labial or gingival side of the affected tooth. The gums are red, edematous and have a bright surface. In the early stage of abscess, inflammatory infiltration is extensive, which makes the tissue tension more severe, the pain is more severe, and there may be pulsatile pain. The tooth has a "floating sensation", pain and looseness. In the later stage of abscess, the pus is confined, the surface of the abscess is soft, and the percussion may have a sense of fluctuation, and the pain is slightly relieved. At this time, the gingival fistula may have pus left from the bag, or the abscess may rupture from the surface and the abscess subsides. Patients with acute periodontal abscess generally have no obvious systemic symptoms, and may have localized lymphadenopathy or a slight increase in white blood cells. Abscesses can occur in a single tooth, the root of the molar is more common, or it can occur in multiple teeth at the same time, or one after another. Patients with such multiple periodontal abscesses are very painful and often accompanied by more obvious general malaise. Due to the shallow position of the periodontal abscess, most of them can rupture and drain on their own, but in the case of systemic diseases, or other unfavorable factors, the extent of inflammation may also spread.

Chronic periodontal abscess is often not treated in time after the acute phase, or repeated acute attacks. Generally no obvious symptoms, there are sinus openings on the surface of the gums, the opening can be flat, you must check carefully to see the opening with a large needle tip; it can also be an opening of granulation tissue hyperplasia, a little pus out when pressed. The pain is not obvious, and sometimes there is a bite discomfort.

Examination of periodontal abscess

1. An elliptical or hemispherical swelling protrusion is formed on the labial or buccal side of the affected tooth. The gums are red, edematous and have a bright surface. The pain is more severe, sore and loose. In the later stage of abscess, the pus is confined, the surface of the abscess is soft, and the percussion may have a sense of volatility. At this time, the gingival fistula may have pus left from the bag, and there may be local lymphadenopathy.

2, blood routine and oral X-ray examination.

Diagnosis and diagnosis of periodontal abscess

diagnosis

Elliptical or hemispherical swelling protrusions are formed on the labial or lingual gingiva of the affected tooth. The gums are red, edematous and have a bright surface. The pain is more severe, sore and loose. In the later stage of abscess, the pus is confined, the surface of the abscess is soft, and the percussion may have a sense of volatility. At this time, the gingival fistula may have pus left from the bag, and there may be local lymphadenopathy. According to the above clinical manifestations combined with blood routine and oral X-ray examination, the diagnosis was made.

Differential diagnosis

Periodontal abscess should be distinguished from gingival abscess and alveolar abscess.

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