Gingival Abscess

Question 1

What’s Gingival Abscess, sources and cp?

Answer 1

localized, acute inflammatory lesion involving marginal gingiva or inder dental papilla.

The lesion may arise from a variety of sources including :

1- Microbial plaque infection

2- Trauma

3- Foreign body impaction

Clinical features :

Appear as a red, smooth, shiny surface, sometimes painful, fluctuant swelling.

Question 2

What’s Periodontal Abscess? Where is it found?

Answer 2

An acute exacerbation of a preexisting pocket,result from exudate and purulent material being entrapped in the pocket with no pathway for drainage .

1-Found in patients with untreated periodontitis, and in association with moderate to deep periodontal pockets. 2-Primarily related to incomplete calculus removal . 3- Tooth perforation or fracture .

4-Poorly controlled diabetes mellitus has been considered a predisposing factor for periodontal abscess formation.

Question 3

C.p of acute Periodontal Abscess?

Answer 3

Clinical features (Acute pd.abscess) 1-painful

2- edematous, red, shiny ovoid elevation of marginal, attach gingiva or both

3- Fever appearance, elevation in temperature , and tendency to malaise.

Acute abscess may progress to chronic abscess if purulence content drains or exudate through fistula or sulcus

Question 4

Differentiate Periodontal Abscess Vs Pulpal Abscess

Answer 4

Question 5

Differentiate Acute abscess vs chronic abscess

Answer 5

Question 6

What’s treatment of gingival abbess

Answer 6

1- Local anesthesia.

2. -Incise fluctuant area (15 blade)& gently widen the incision for drainage.
3. • Area cleaned with warm water & covered with gauze. 4- After bleeding stops, pt. dismissed within 24 hr with instruction (every 2 hr rinsing with a glass full of warm water).

Question 7

What are Treatment options (Periodontal abscess)?

Answer 7

A- Drainage through pocket retraction or incision from outer surface B- Scaling & Root

planing C- Periodontal

surgery

D- Systemic antibiotics 1- Acute Abscess

Question 8

What’s purposes of treatment of acute abscess

Answer 8

The purposes of treatment are to :

1- Alleviate symptoms.

2- Control spread of infection.

3- Establish drainage.

● Before treatment, the patient’s medical history, dental history and systemic condition are reviewd.

Question 9

What’s procedure of

Answer 9

Drainage through periodontal pocket retraction:

1- Anesthetize the area topically or by local anesthesia (which injected around periphery of lesion).

2. -A flat instrument or probe is inserted to the pocket to distend pocket wall for drainage ,and curette can be inserted into pocket for further drainage and curration of the tissue internally .
3. • Gentle digital pressure & irrigation to express
     exudates. 4- Small lesion, scaling & root planing for debridement.

5- large lesion, root debridement by scaling and polishing

Question 10

What’s the procedures for B-Drainage through external incision:

Answer 10

1. Isolate & dry area with gause sponges. After topical anas., application ,local anesthesia is injected around periphery of abs.
2. Vertical incision was made through the most fluctuant part of the abscess (no. 15 blade)extending into area just apical to the abscess.
3. Tissue elevated by curette or periosteal elevator to drain & curette gran. tissue internally
4. Externally, push the abscess to drain remaining purulent material, and approximate wound edges.
5. After drainage stops, the area is dried and paint with
   antiseptic. 6- No suturing.
6. Instruct patient to rinse with ( 1 tsp of salt in glass of water), in addition to prescription ofantibiotics and analgesic, bed rest, avoid exertion, placed on a copious fluid and return for follow up evaluation for the next day
7. Next day, reduced swelling & symptoms subside.

Question 11

What are Indications for antibiotic therapy in acute abscess:

Answer 11

1- Cellulitis (non localized, spreading

infection).

2- Deep inaccessible pocket.

3. Fever
4. Regional lymphadenopathy.
5. Immunocompromised patient

Question 12

Antibiotic options for periodontal infections:

Answer 12

1. -Amoxicillin,
   - 1.0 g loading dose, then 500 mg three times a day for 3 days.
   - Reevaluation after 3 days to determine need for continued or adjusted antibiotic therapy. Penicillin allergy:
2. -Clindamycin
   - 600 mg loading dose, then 300 mg four times a day for 3 days.

3- Azithromycin (or clarithromycin)

• 1.0 g loading dose, then 500 mg four times a day for 3 days.

Question 13

What’s procidure for chronic abscess

Answer 13

When acute pd .absc. Become chronic,the treatment is by

flap.

1. Probing around gum following tortuous pocket.
2. Local anesthesia & removal of supragingival
   calculus. 3- Two vertical incisions made from gum to beyond MGJ. 4- Operating field wide enough.
3. Mesiodistal incision across interdental papilla for detachment of flap.
4. Full thickness flap elevated with periosteal elevator. 7- Scaling & root planing.
5. Pathological marginal bone is removed & antibiotics may be prescribed.

Question 14

What are post surgical instructions

Answer 14

1. No rinsing until next day.
2. Mouth gently brushed with soft tooth brush and water irrigation.
3. Patient returns back after a week to remove suture and pack.
4. Plaque control.
5. After 6-8 weeks, gingiva returns to normal. Bone repair needs 9 months.