This is an extremely painful condition which is basically a consequence of an untreated periodontitis. This is a deposit of pus being developed in the periodontal area and is manifested as a painful swell in the root of the infected tooth. The pus usually creates itself during a strong inflammatory reaction and is contained from dissolved remaining of bacteria and damaged tissue. It is a fluid of thick yellow texture, carrying an unpleasant odor as well. During periodontitis in the periodontal pocket there is a bigger amount of pus deposit which initially flows freely through this opening. Once the periodontitis advances into the depth of the pocket or the pocket clogs up, the pus can no longer flow out and this is what causes periodontal abscess. As it is with many other abscesses, the principle of therapy revolves around allowing the pus to flow out again, which a process is usually done surgically. Once this is done, it’s necessary to start treating the periodontitis which caused the abscess in the first place.
There is also a chronic type of this inflammation which doesn’t manifest itself with a swelling. With this type there is a fistula formulated – a small channel through which the pus is running out of the area of inflammation into the oral cavity. Since the pus is flowing freely and doesn’t deposit there is no abscess to be created, as well as no swelling or pain. Fistula can be noticed as a bump on the gingiva, carrying a radius of just a couple of millimeters by pressing on which the pus starts running out. Subjective symptoms in this form of inflammation are usually missing, but there is still an emergent treatment required because it’s obviously an advanced stage of this inflammation which causes irreparable damage to the periodontal area.
We know of three different approaches to the treatment – drainage and removal of deposits, systematic antibiotics and periodontal surgery. The most important and first step needed to be taken in treatment is allowing drainage to happen with eventual incision of the abscess. Drainage is accomplished exclusively by scrubbing and polishing the root area, whether with a tool or manually. Mechanical removal of deposits also has a goal of accomplishing drainage and removing microorganisms. In the acute phase of the inflammation it’s not recommended to use local antibiotics or antiseptics because these can severely jeopardize the whole drainage procedure even though they do have a strong bactericidal effect.
Duration of the antibiotic therapy has gradually been shorted over the last couple of years. Some don’t recommend this therapy to last longer than 10 days and many dentists prescribe a penicillin treatment through 5 days and other medications for up to 3 days. On the other hand, when treating this condition, caution is required as there might be some highly resistant bacteria species so a longer antibiotic treatment is recommended. There are lots of different bacteria out there and many of them have become highly resistant to known antibiotics, so an analysis of the bacteria is required to know more specific details about the treatment.