The periodontal abscess: a review

Abstract

The periodontal abscess is the 3rd most frequent dental emergency, and it is specially prevalent among untreated periodontal patients and periodontal patients during maintenance. Different etiologies have been proposed, and 2 main groups can be distinguished, depending on its relation with periodontal pockets. In the case of a periodontitis-related abscess, the condition may appear as an exacerbation of a non-treated periodontitis or during the course of periodontal therapy. In non-periodontitis related abscesses, impaction of foreign objects, and radicular abnormalities are the 2 main causes. The abscess microflora seems to be similar to that of adult periodontitis, and it is dominated by gram-negative anaerobic rods, including well-known periodontal pathogens. Complications and consequences include tooth loss and the spread of the infection to other body sites. Diagnosis and treatment is mainly based on empiricism, since evidence-based data are not available. The role of systemic antibiotics, in the treatment of periodontal abscesses, is especially controversial.

Utilizzo degli antibiotici: risultati di un sondaggio condotto su un campione di dentisti italiani

“…Se si tiene conto delle premesse al questionario, ossia l'uso dell'antibiotico a solo scopo terapeutico, e che i quadri clinici per i quali ne è indicato l'impiego hanno una prevalenza relativamente bassa (ascesso parodontale: 12%; forme aggressive: 14-25%) tale abitudine prescrittiva appare eccessiva [12] .…”

“…Le raccomandazioni scientifiche, qualora sia necessario il ricorso all'antibiotico, individuano l'amoxicillina come mono terapia o nelle forme più gravi in associazione all'acido clavulanico, l'antibiotico di prima di scelta [11,12] .…”

“…Deve essere comunque evidenziato che si tratta di forme la cui prevalenza si attesta attorno al 12% per quelle aggressive e al 14-25% per l'ascesso parodontale [12] . La scelta di un antibiotico sistemico da parte dei dentisti sembra spesso basarsi più su abitudini e consuetudini che non su evidenze scientifiche.…”

Evaluation of the use of systemic antimicrobial agents by professionals for the treatment of periodontal diseases

“…Different therapies have been proposed for the treatment of periodontal abscesses, which turned the subject controversial 1,24,25 . However, the use of antibiotics must be restricted to individuals with systemic involvement such as bad feeling, fever, prostration and lymphoadenopathy 26 .…”

Microbiological Aspects and Inflammatory Response of Pulp Tissue in Traumatic Dental Lesions

“…In the case of chronic inflammation, an irreversible destruction ofthe parenchymal tissue has been noticed, and the restructuring with connective and fibrous tissue of the resulting defect, as well as the activation of the cell-mediated bacterial lysase with the activation of the T and B cells and of the cytokine system (36)(37) Periapical inflammation occurs as a consequence of pulp inflammation following trauma, carious process or iatrogenic damage, and such inflammation stimulates the formation ofgranulomae and cysts with consequent bone inflammation. The inflammatory response consists of an initial vasodilatation, an increase of the vascular permeability, infiltration of leucocytes regulated by endogenic mediators such as neuropeptide quinine, migration of polimorphonuclear leucocytes and monocytes, cytokines.…”