33 Indian Journal of Multidisciplinary Dentistry, Vol.

1, Issue 1, Nov-Dec 2010

A
bscesses are one of the main causes for patients
to seek emergency care in the dental clinic.
Odontogenic abscesses include a broad group
of acute infections that originate from the tooth
and/the periodontium. Abscesses are associated with
an array of symptoms, including a localized purulent
inammation, in the periodontal tissues which causes
pain and swelling.
Defnitions
Gingival Abscess
Acute inammatory condition of the gingiva
characterized by purulent exudates without attachment
loss. Following traumatic insult: e.g., injury by a sh
bone, tooth brush bristle, etc., implantation of virulent
bacteria into the gingival connective tissue leads to
excessive gingival inammatory reaction.
A gingival abscess was also dened as a localized
purulent infection that involves the marginal gingiva
or interdental papilla.
1
Classifcation of Abscesses
I. Chronic/acute
Single/multiple
Gingival/periodontal
n
n
II. Gingival abscesses in previously healthy sites and
caused by foreign body impaction.
Periodontal abscesses are chronic or acute in
relation to a periodontal pocket.
Pericoronal abscesses in incompletely erupted
teeth.
1
III. Based on etiology
Periodontitis related acute infection originates
from bacteria present at the subgingival biolm
in a deepened periodontal pocket.
Nonperiodontal related abscesses when the
acute infection originates from bacteria
originating from another local source such as
foreign body impaction, or from alteration in
the integrity of the root leading to bacterial
colonization. Impaction of foreign body in the
gingival sulcus or periodontal pocket.
2
Periodontal Abscesses in the Absence of
Periodontitis
Periodontal abscesses can also develop in the absence
of periodontitis, due to the following causes:
Impaction of foreign bodies,
3
such as an orthodontic
elastic,
4
a piece of dental oss,
2
a popcorn kernel,
5

a dislodged cemental tear,
6
a piece of a toothpick, a
corn husk in peri-implant tissues
7
or an unknown
object.
8
Periodontal abscesses caused by foreign
bodies, related with oral hygiene aids, have been
named oral hygiene abscesses.
Perforation of the tooth wall by an endodontic
instrument.
9
Infection of lateral cysts; local factors aecting
n
n
n
n

*Professor and Head

*Professor

PG Student III Year

Dept. of Periodontics
Sree Balaji Dental College and Hospital, Chennai
E-mail: [email protected]
ABSTRACT
Aim: Te aim of the present article was to critically evaluate the available literature regarding gingival abscess and highlight
a case report. Background: Abscesses are one of the main causes for patients to seek emergency care in the dental clinic. Tis
condition 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 impacted
food. Conclusion and clinical signicance: It becomes necessary that we bear this basic fact in mind when we come across
such 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
Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 1, Nov-Dec 2010 34
CASE REPORT
the morphology of the root may predispose to
periodontal abscess formation. Te presence of
cervical cemental tears has been related to rapid
progression of periodontitis and the development
of abscesses.
6,10
Te presence of external root
resorption,
11
an invaginated tooth,
12
or a cracked
tooth,
13
have been also suggested as predisposing
factors for periodontal abscess formation.
Microbiology
Review articles have pointed out that purulent oral
infections are polymicrobial, and caused by endogenous
bacteria.
14
However, very few studies have investigated
the specic microbiota of a gingival abscess. Hafstrm
et al
15
reported a microora harboring >10
6
total viable
counts per sample. Topoli et al
16
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 information
can 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 conned to marginal gingival tissues,
often at previously nondiseased sites. It is often an acute
inammatory response to the impaction of a foreign
body or material into the gingiva from the oral surface
or from the gingival sulcus. Te nding and retrieval of
the oending foreign material is, thus, often diagnostic.
Te diagnosis of a gingival abscess can be made on the
basis of a history of 1-2 days of pain and a localized
gingival swelling and the clinical nding of a red, shiny
swelling conned 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 specic aggravating and relieving
factors. History revealed that he had pricked the area
with a matchstick eight days ago while attempting to
remove impacted food.
On examination, there was a soft, uctuant
swelling in relation to 26, 27 with pus discharge.
Te swelling was 3 2 mm ovoid in shape, and conned
to the marginal gingiva (Fig. 1). On palpation, there
was pain and exudate.
Intraoral periapical radiograph 26, 27 did not reveal
any alterations in bone levels or periapical changes
(Fig. 2). Considering the history, symptoms and clinical
and radiographic ndings, the lesion was provisionally
diagnosed to be a gingival abscess.
Differential Diagnosis
Acute gingival inammatory enlargement
Periodontal abscess
Management
Antibiotics and anti-inammatory drugs were
prescribed. Te patient was prescribed amoxycillin

Figure 2. Intraoral periapical radiograph 26, 27.

Figure 1. Patient presenting with abscess in 26, 27 region.
35 Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 1, Nov-Dec 2010
CASE REPORT
250 mg thrice-daily day and metronidazole 400 mg
thrice-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 dened according to their
infection 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.
23
Te abscess microora 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 Signifcance
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.
Indian Journal of Multidisciplinary Dentistry, Vol. 1, Issue 1, Nov-Dec 2010 36
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 we
arrive at a conclusive diagnosis.
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