This is a review and update on acute conditions affecting the gingival tissues, including abscesses in the periodontium, necrotizing periodontal diseases, and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, muco--cutaneous disorders, and traumatic and allergic lesions. A periodontal abscess is clinically important since it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth, and because bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly by the type of etiology, and there are clear differences between those affecting a previously existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, with individual evaluation of the need for systemic antimicrobial therapy. The definitive treatment of the pre--existing condition should be accomplished after the acute phase is controlled.