Periodontal Abscess

Periodontal Abscess is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Collection of pus in supporting structures of teeth:
    • Periodontal ligament
    • Alveolar bone
  • Periodontal pockets result from progression of periodontal disease and resultant bone loss:
    • Food and debris accumulate in periodontal pockets
    • Coronal epithelial tissues can reattach to tooth while bacteria and food debris remain trapped in pocket, impairing drainage
    • Food and debris become secondarily infected in the setting of impaired drainage
  • Complications:
    • Osteomyelitis
    • Dentocutaneous fistula
    • Cavernous sinus thrombosis
    • Ludwig angina
    • Maxillary sinusitis
    • Mediastinitis
    • Tooth loss
    • Sepsis

Pediatric Considerations
  • Periodontal abscess is rare in children
  • Periapical abscess is more common:
    • Originates in pulp
    • Associated with caries

Etiology

  • Anaerobic gram-negative rods
  • Peptostreptococci
  • Viridans group streptococci
  • Neisseria species
  • Usually polymicrobial

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Basics

Description

  • Collection of pus in supporting structures of teeth:
    • Periodontal ligament
    • Alveolar bone
  • Periodontal pockets result from progression of periodontal disease and resultant bone loss:
    • Food and debris accumulate in periodontal pockets
    • Coronal epithelial tissues can reattach to tooth while bacteria and food debris remain trapped in pocket, impairing drainage
    • Food and debris become secondarily infected in the setting of impaired drainage
  • Complications:
    • Osteomyelitis
    • Dentocutaneous fistula
    • Cavernous sinus thrombosis
    • Ludwig angina
    • Maxillary sinusitis
    • Mediastinitis
    • Tooth loss
    • Sepsis

Pediatric Considerations
  • Periodontal abscess is rare in children
  • Periapical abscess is more common:
    • Originates in pulp
    • Associated with caries

Etiology

  • Anaerobic gram-negative rods
  • Peptostreptococci
  • Viridans group streptococci
  • Neisseria species
  • Usually polymicrobial

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