From the Guidelines
The treatment of a periodontal abscess involves immediate drainage of the abscess, which can be achieved through scaling and root planing of the affected area, or by making an incision directly into the abscess, as recommended by the most recent guidelines 1.
Key Considerations
- Initial treatment focuses on drainage of the abscess to alleviate pain and prevent further infection.
- Antibiotics may be prescribed in certain cases, such as in patients with systemic signs of infection, immunocompromised patients, or if source control is incomplete, with amoxicillin 500mg three times daily for 7 days being a common first-line choice 1.
- For patients allergic to penicillin, clindamycin 300mg four times daily for 7 days is an alternative 1.
- Pain management with analgesics such as ibuprofen 400-600mg every 6-8 hours or acetaminophen 500-1000mg every 6 hours is recommended 1.
Follow-up Care
- Following resolution of the acute infection, comprehensive periodontal therapy is necessary to address the underlying cause, which may include thorough scaling and root planing, possible surgical intervention for pocket reduction, and improved oral hygiene practices 1.
- Patients should rinse with warm salt water (1/2 teaspoon salt in 8 ounces of water) several times daily to promote healing.
- The periodontal abscess is caused by bacterial infection within a periodontal pocket, often due to plaque accumulation and poor oral hygiene, so addressing these factors is crucial for preventing recurrence 1.
From the Research
Treatment Guideline for Periodontal Abscess
The treatment guideline for a periodontal abscess involves a combination of drainage, tissue debridement, and evaluation of the need for systemic antimicrobial therapy 2, 3. The goal of treatment is to manage the acute lesion and then provide comprehensive treatment of the original and/or residual lesions.
Management of Acute Lesions
The management of acute lesions includes:
- Establishing drainage via pocket lumen
- Subgingival scaling and root planing
- Curettage of the lining pocket epithelia and seriously inflamed connective tissue
- Compressing pocket wall to underlying tooth and periodontal support
- Maintaining tissue contact 2
Systemic Antibiotics
Systemic antibiotics may be recommended as a preventive measure of systemic disease or in case of systemic symptoms 2. The use of systemic metronidazole and amoxicillin in combination with scaling and root planing has shown to be an effective periodontal treatment 4.
Definitive Treatment
The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled 3. This may involve comprehensive treatment of the original and/or residual lesions, including appropriate therapy for the pre-existing gingivitis or periodontitis.
Other Treatment Options
Other treatment options may include:
- Incision or establishment of drainage and irrigation
- Flap surgery
- Extraction of hopeless teeth 2
- Root conditioning with doxycycline 5
Importance of Proper Diagnosis
Proper diagnosis is important for adequate management of the case 3. The diagnosis of a periodontal abscess is based on medical and dental history as well as oral examination, including pocket depth, swelling, suppuration, mobility, and sensibility of the tooth 2.