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33Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 1, Nov-Dec 2010

Abscesses are one of the main causes for patientsto seek emergency care in the dental clinic.

Odontogenic abscesses include a broad groupof acute infections that originate from the tooth

and/the periodontium. Abscesses are associated withan array of symptoms, including a localized purulent

inflammation, in the periodontal tissues which causespain and swelling.

Denitions

Gingival Abscess

Acute inflammatory condition of the gingivacharacterized by purulent exudates without attachment

loss. Following traumatic insult: e.g., injury by a fishbone, tooth brush bristle, etc., implantation of virulent

bacteria into the gingival connective tissue leads toexcessive gingival inflammatory reaction.

A gingival abscess was also defined as a localizedpurulent infection that involves the marginal gingiva

or interdental papilla.1

Classication of Abscesses

I. Chronic/acute

Single/multiple

Gingival/periodontal

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II. Gingival abscesses in previously healthy sites andcaused by foreign body impaction.

Periodontal abscesses are chronic or acute inrelation to a periodontal pocket.

Pericoronal abscesses in incompletely eruptedteeth.1

III. Based on etiology

Periodontitis related acute infection originatesfrom bacteria present at the subgingival biofilmin a deepened periodontal pocket.

Nonperiodontal related abscesses when theacute infection originates from bacteriaoriginating from another local source such asforeign body impaction, or from alteration inthe integrity of the root leading to bacterialcolonization. Impaction of foreign body in thegingival sulcus or periodontal pocket.2

Periodontal Abscesses in the Absence ofPeriodontitis

Periodontal abscesses can also develop in the absence

of periodontitis, due to the following causes:

Impaction of foreign bodies,3such as an orthodonticelastic,4a piece of dental floss,2a popcorn kernel,5a dislodged cemental tear,6a piece of a toothpick, acorn husk in peri-implant tissues7or an unknownobject.8 Periodontal abscesses caused by foreignbodies, related with oral hygiene aids, have beennamed oral hygiene abscesses.

Perforation of the tooth wall by an endodonticinstrument.9

Infection of lateral cysts; local factors affecting

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*Professor and Head*ProfessorPG Student III YearDept. of PeriodonticsSree Balaji Dental College and Hospital, Chennai

E-mail: ijmdent@gmail.com

ABSTRACT

Aim:Te aim of the present article was to critically evaluate the available literature regarding gingival abscess and highlighta case report. Background:Abscesses are one of the main causes for patients to seek emergency care in the dental clinic. Tiscondition has clinical implications, not only diagnostic, but also, prognostic and therapeutic, in everyday periodontal practice.Case description: Tis case report especially highlights the prevalence of the use of inappropriate aids to remove impactedfood. Conclusion and clinical significance: It becomes necessary that we bear this basic fact in mind when we come acrosssuch periodontal emergencies before we arrive at a conclusive diagnosis.

Key words: Periodontal emergency, gingival abscess, matchstick

Gingival Abscess Revisited

SC Chandrasekaran*, V Bagavad Gita**, P Preethi

CASE REPORT

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Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 1, Nov-Dec 201034

CASE REPORT

the morphology of the root may predispose toperiodontal abscess formation. Te presence ofcervical cemental tears has been related to rapidprogression of periodontitis and the development

of abscesses.

6,10

Te presence of external rootresorption,11 an invaginated tooth,12 or a crackedtooth,13 have been also suggested as predisposingfactors for periodontal abscess formation.

Microbiology

Review articles have pointed out that purulent oral

infections are polymicrobial, and caused by endogenous

bacteria.14However, very few studies have investigated

the specific microbiota of a gingival abscess. Hafstrm

et al15reported a microflora harboring >106total viable

counts per sample. opoli et al16 and Newman and

Sims,17 reported that around 60% of cultured bacteria

were strict anaerobes. It was further described that

the most frequent type of bacteria were gram-negative

anaerobic rods and gram-positive facultative cocci.

In general, gram-negatives predominated over gram-

positives, and rods over cocci with percentages ranging

between 40% and 60% for each group.

Diagnosis

Te diagnosis of a gingival abscess is based on the

symptoms revealed by the patient, and the signs found

during the oral examination. Additional informationcan be obtained through a careful medical and dental

history, and radiographic examination.

Te diagnosis of a gingival abscess is uncomplicated, as a

gingival abscess is confined to marginal gingival tissues,

often at previously nondiseased sites. It is often an acute

inflammatory response to the impaction of a foreign

body or material into the gingiva from the oral surface

or from the gingival sulcus. Te finding and retrieval of

the offending foreign material is, thus, often diagnostic.

Te diagnosis of a gingival abscess can be made on thebasis of a history of 1-2 days of pain and a localized

gingival swelling and the clinical finding of a red, shiny

swelling confined to the marginal gingival tissues.

Case Description

A male patient aged 19 years, visited the Periodontics

OPD of Sree Balaji Dental College, complaining

of pain and swelling in the upper left back tooth

region for the past three days. Te pain was dull and

continuous with no specific aggravating and relieving

factors. History revealed that he had pricked the areawith a matchstick eight days ago while attempting to

remove impacted food.

On examination, there was a soft, fluctuantswelling in relation to 26, 27 with pus discharge.Te swelling was 3 2 mm ovoid in shape, and confined

to the marginal gingiva (Fig. 1). On palpation, therewas pain and exudate.

Intraoral periapical radiograph 26, 27 did not revealany alterations in bone levels or periapical changes

(Fig. 2). Considering the history, symptoms and clinicaland radiographic findings, the lesion was provisionally

diagnosed to be a gingival abscess.

Differential DiagnosisAcute gingival inflammatory enlargement

Periodontal abscess

Management

Antibiotics and anti-inflammatory drugs wereprescribed. Te patient was prescribed amoxycillin

Figure 2. Intraoral periapical radiograph 26, 27.

Figure 1. Patient presenting with abscess in 26, 27 region.

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35Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 1, Nov-Dec 2010

CASE REPORT

250 mg thrice-daily day and metronidazole 400 mgthrice-daily with ibuprofen 400 mg thrice-daily for

three days. Supragingival scaling was done and scaling

and root planing was done in relation to 26, 27 under

local anesthesia (Fig. 3). During this procedure, the

portion of the matchstick (3.5 cm) used to remove

the impacted food was retrieved (Fig. 4). Te patient

was put on maintenance therapy after review was

done (Fig. 5).

Discussion

Odontogenic infections have various possible sources,

including pulp necrosis, periodontal infections,

pericoronitis, trauma or surgery.18 Odontogenic or

dental abscesses have been defined according to theirinfection source, as endodontal or periapical abscess,

periodontal abscess and pericoronal abscess.19

Tis

nomenclature, however, is somehow confusing, since

abscesses of pulp necrosis origin have been referred both

as dental or periapical or dentoalveolar abscesses.20

Acute dentoalveolar abscesses have been termed as the

most common infections in dentistry that demand

emergency treatment.21

However, in order to render

appropriate therapy, it is important to distinguish

among abscesses of endodontal and periodontal origin.22

In nonperiodontitis-related abscesses, impaction of

foreign objects and radicular abnormalities are the

two main causes. In this case report, the foreign body

impacted was a matchstick used to remove impacted

food between 26, 27.

Gingival abscess formation has also been reported

following subepithelial connective tissue graft for root

coverage.23Te 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.

Te role of systemic antibiotics, in the treatment

of periodontal abscesses, is especially controversial.

Recently, a novel vaccine targeting Fusobacterium

nucleatum inducing protective immunity provides an

alternative option to conventional antibiotic treatments

for chronic halitosis-associated with abscesses.24

Conclusion and Clinical Signicance

Tus, from the above article, it is evident that

emergencies are not uncommon in periodontal practice.

Eliciting a proper history with systematic clinical

and periodontal examination is the key to successful

diagnosis and management of periodontal emergencies.

Tis case report especially highlights the prevalence of

the use of inappropriate aids to remove impacted food

Figure 3. Scaling and root planing done.

Figure 4. Impacted matchstick.

Figure 5. Postoperative picture after a week.

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Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 1, Nov-Dec 201036

CASE REPORT

even among youth in a metropolitan city like Chennai.

It is important to bear this basic fact in mind when we

come across such periodontal emergencies before wearrive at a conclusive diagnosis.

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