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
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
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