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  Mouth Abscesses - Periodontal Abcesses  

This is also known as periodontal abscesses, and are common infections of tissues that surround a tooth. These tissues are easily destroyed, leading to tooth loss and spread of infection in other body parts. Since there is little information on this condition, this is just based on empirical observations with no evidence. In cases like this, immediate treatment should be done upon detection.

Causes of mouth abcesses

Majority of mouth abscesses are interlinked with areas with periodontitis pockets and areas with no previous periodontal pocket.

Periodontitis occurs during a period of active bone damage. Due to this destruction, it will create pockets that can promote the development of mouth abscesses. The subsidiary closure of these pockets can promote spread of infections to nearby tissues due to the pressure being exhibited by inefficient pus drainage from a closed pocket.

Mouth abscesses also occur in the absence of prior periodontal pockets. This may be due to foreign body impaction, like orthodontic elastic, dental floss, popcorn kernel, toothpick, or other foreign materials. Additional risk factors are local factors that affect the morphology of the root, presence of external root resorption, invaginated tooth, or a broken tooth.

Mouth abscesses can occur in numerous stages in the course of an infection, where the condition manifests an acute exacerbation of untreated periodontitis. Mouth abscesses are related to therapy in numerous reasons. When this occurs immediately post scaling or prophylaxis, it may be because of calculus fragments that are pushed deep in the tissues. Inadequate scaling can also leave a few calculus fragments in the deepest pocket site while the resolution of the condition in the coronal pocket area creates inadequate drainage, causing an abscess formation. Systemic antibiotics without subgivgival bridement used in advanced periodontitis causes mouth abcesses.

Classification of mouth abscesses

There are many classifications for mouth abscesses. These are categorized as periodontal and gingival abscess, depending on its location. Gingival abscess is contained, and is manifested by swelling and pain and only affects the marginal and soft tissues of the healthy areas. Impaction of a foreign material may also be present from a previous healthy gingival. Periodontal abscess may manifest similar symptoms with a deeper tissue involvement and areas that are destroyed by periodontitis, which changes the root integrity. This type is utilized more than others.

This is further classified into acute and chronic according to its course of condition. The acute condition manifests pain, tenderness, sensitivity to touch and pus oozing when gentle pressure is applied. Chronic condition is asymptomatic which is interlinked with the sinus tract. With acute abscess, this may be chronic when the sinus or sulcus has drainage. Chronic abscesses can also be acute.

Furthermore, this can be categorized as single or multiple mouth abscesses according to its number. Local factors can cause single abscesses that may result to closure of drainage in the periodontal pocket. Multiple abscesses are interlinked with local factors, medical conditions including diabetes mellitus, immunocompromised clients, and clients with untreated periodontitis post systemic antibiotic treatment.

Pathogenesis of mouth abcesses

Portal of entry for bacteria is through soft tissue pocket wall, which is the first encounter in mouth abscess formation. Inflammatory cells react to bacterial invasion, causing infection then destruction of connective tissues, encapsulation of bacterial infection, and pus formation. There are no known microorganisms implicated in periodontal pathogens, but P. gingivalis; P. intermedia and F. nucleatum are suspected.

Diagnosis of mouth abcesses

Diagnosis of this is based on symptoms presented and through oral assessment. Present sign of this assessment is an elevation of ovoid in the gingival along the lateral root; deeper abscesses are less conspicuous. Manifestations involved are slight discomfort to severe pain, gingival tenderness, swelling tooth mobility, tooth elevation and tooth sensitivity to touch. Other symptoms include pus oozing upon pressure, tissue destruction and deep pocket formation. Radiography reveals loss of bone.

Mouth abscesses and other forms of mouth abscesses might present similar manifestations, so a differential diagnosis is imperative.

Treatment of mouth abcesses

Currently, there is no special treatment for mouth abscesses. Basic treatments such as incision and drainage, systemic antibiotics with or without other treatments and periodontal surgery are always utilized. Clinicians may recommend combination of these. Incision and drainage along with systemic antibiotic therapy is currently a more effective treatment. Penicillin is a preferred drug in treating mouth abscesses then later followed by amoxicillin and metronidazole.

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