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Therapy for a Patient with Periodontal Abscess: Case Report Central JSM Dental Surgery Bringing Excellence in Open Access Case Report *Corresponding author Alparslan DILSIZ, Department of Periodontology, Faculty of Dentistry, Atatürk University, 25240-Erzurum, Therapy for a Patient with Turkey, Tel: 90 442 2360940; Fax: 90 442 2361375; Email: Submitted: 27 April 2017 Periodontal Abscess: Case Accepted: 20 June 2017 Published: 23 June 2017 Report Copyright © 2017 Dilsiz et al. Alparslan Dilsiz1* and Aziz Sahin Erdogan2 ISSN: 2573-1548 1Department of Periodontology, Atatürk University, Turkey 2 Department of Endodontics, Atatürk University, Turkey OPEN ACCESS Abstract Keywords • Periodontal abscess The periodontal abscesses are localized purulent infections of periodontal tissue. • Periodontal pocket The periodontal abscess is the third most frequent dental emergency and it is specialy • Suppuration prevalent among untreated periodontal patients and periodontal patients during • Anti-bacterial agents maintenance. In this article, a patient with periodontal abscess due to poor oral hygiene • Periodontal atrophy was treated periodontically 3 days after the start of antibiotic therapy. Periodontal • Periodontal debridement maintenance therapy was provided every 2 weeks. The clinical features and likely healing results of the lesion were discussed and related literatures were reviewed. INTRODUCTION Periodontal abscesses are termed ‘mixed anaerobic infections’, The periodontal abscess, which is a localized purulent species can also be recovered from periodontal abscesses [6,7]. infection of the periodontal tissues adjacent to a periodontal Thebased periodontal on microbiological abscess findingsis the third [2,3]. most Herpesvirus prevalent and emergency Candida pocket, is a frequent periodontal condition in which periodontal infection (%6-7), after acute dento-alveoler abscess (%14-25), tissues may be rapidly destroyed [1, 2]. The major symptoms of and pericoronitis (%10-11) [9,10]. a periodontal abscess are spontaneous or evoked pain, gingival or mucosal swelling, affected tissue appears red or reddish blue [1-4]. Affected teeth typically experience rapid periodontal tissue spread of the infection to other body sites [5-8]. In fact, abscess destruction with deep pocket formation, frequently become formationComplications in the periodontium and consequences is a relatively include rare tooth occurrence loss and [3].the hypermobile, and may sometimes extrude from the alveolar CASE REPORT socket [4]. Suppuration may appear spontaneously or after incision of the abscess [3,4]. The diagnosis of a periodontal abscess In March 2015, a 38-year-old Turkish male (weight, 78.4 is based on information from patient history and clinical and kg; height, 1.76m) with severe pain, swelling, excessive gingival radiographic examinations. The lesions may be acute or chronic bleeding, refractory gingival reddish, tenderness to even slight [5]. Differential diagnosis between abscesses of periodontal palpation on the upper anterior region, which was interfering and endodontic origin can be made on the basis of pulp vitality, with normal eating, brushing and speaking, was admitted to the the presence of deep periodontal pockets versus dental caries, Department of Periodontology, Faculty of Dentistry at Atatürk the location of the abscess, radiographic examination, and the University. response to periodontal therapeutic intervention [5]. This infection occurs in the walls of periodontal pockets as a result of the invasion of bacteria into the periodontal tissues. not Hetake claimed alcoholic to beverages.be in relatively The patient good health reported and that had he not had a Different etiologies have been proposed and two main groups ahistory severe of toothache drug and offood maxillary allergies. right He incisorsdid not teethsmoke the and night did can be distinguished depending on its relation with periodontal before. pockets [5-9]. In the case of a periodontitis-related abscess, The extraoral examination revealed a dismorphic face. The the condition may appear as an exacerbation of a non-treated temperature measured 38.7 o periodontitis or during the course of periodontal therapy [10]. In non-periodontitis-related abscesses, impactation of foreign enlarged and tender lymph nodesC, pulse were was present 74 beats bilaterally per minute, in the objects, and radicular abnormalities are the two main causes submandibularand blood pressure areas. was 114/78 mmHg. In addition, a few periodontitis, and it is dominated by gram-negative anaerobic The intra-oral examination revealed that he was suffering rods,[10,11]. including The abscess well-known microflora seemsperiodontal to be similar pathogens to that of adult[12]. from severe pain, swelling, gingival bleeding and disfunction. Cite this article: Dilsiz A, Erdogan AS (2017) Therapy for a Patient with Periodontal Abscess: Case Report. JSM Dent Surg 2(3): 1021. Dilsiz et al. (2017) Email: Central Bringing Excellence in Open Access There was a heavy accumulation of dental plaque, the gingival tissues were swollen (Figure 1). Periodontal pocket was measuremed as 9mm in facial of mandibulary right central and lateral incisors (Figure 2). A occlusal radiograph showed localized alveolar bone resorption with localized angular defects on the right anterior teeth sites (Figure 3). The location and degree of resorption was showed generalized alveolar bone resorption with localized angularcorrelated defects with on inflammatory the molar teeth sites. sites, A indicating panoramic the presenceradiograph of chronic periodontitis (Figure 4). After having undergone clinical Figure 2 A probe inserted through the sulcus, periodontal pocket. examinations, he was diagnosed as having “Acute periodontal abscess”. Written informed consent was obtained from the patient after all treatment procedures had been fully explained. At the conclusion of her periodontal examination, the supragingival irrigation with chlorhexidine were done carefully to remove any local irritating factors that may have been prescribed antibiotics (amoxicillin 1000mg, every 8 hours, 3 days),responsible analgesics for the(Naproxen gingival 550mg,inflammation. every 12The hours, patient 3 days) was and instructed to rinse twice daily with 0.12% chlorhexidine oral rinse for 2 weeks. Three days later, the affected regions of gingiva appeared less painless. Thereafter, a thorough supra- and sub-gingival scaling, root planning and crown polishing were performed carefully and pü was careful drained via probing Figure 3 Occlusal radiograph. was elevated and curettage was performed (Figure 5). Four weeksfrom the following pocket. surgical Twelve periodontaldays later atherapy, full-thicknes the affected buccal areaflap had completely healed, there were no gingival reddish, bleeding was encouraged to practice good oral hygiene with a soft-bristle and swelling, and no lymphadenopathy was noted (Figure 6). He years since that time. toothbrush. He has been visiting a periodontist regularly for two DISCUSSION Periodontal abscesses are the most common type of abscesses including the periodontium. Its importance is based on the possible need of urgent care, the affectation of tooth prognosis, and the possibility of infection spreading [1-6]. In the related literature, there is scant information in the Figure 4 Panoramic radiograph. been published as case reports and text books, where conclusions arescientific not evidence-based, literature regarding but rather this condition,empirical observationsand most of itmade has by recognised clinicians [6-9]. In the present case, periodontal Figure 1 Figure 5 Clinical view of the Periodontal abscess. Clinical view at the time of periodontal surgery. JSM Dent Surg 2(3): 1021 (2017) 2/3 Dilsiz et al. (2017) Email: Central Bringing Excellence in Open Access 2. Jar amillo A, Arce RM, Herrera D, Betancourth M, Botero JE, Contreras A. Clinical and microbiological characterization of periodontal 3. abscesses. J Clin Periodontol. 2005; 32: 1213-1218. 387-394.Herrera D, Roldan S, Gonzalez I, Sanz M. The periodontal abscess (I). Clinical and microbiological findings. J Clin Periodontol. 2000; 27: 4. Carranza FJ. Carranza’s Clinical Periodontology. 9th edn. Philadelphia: 5. W.B. Saunders. 2002; 448-451. periodontal-endodontic lesions. Periodontol 2000. 2002; 28: 206-239. Dahlen G. Microbiology and treatment of dental abscesses and 6. Immunol.Saygun I, Yapar 2004; M, 19: Özdemir 83-87. A, Kubar A, Slots J. Human cytomegalovirus and Epstein-Barr virus type 1 in periodontal abscesses. Oral Microbiol 7. Figure 6 Postoperative result 8 weeks following periodontal therapy. microbial penetration of the soft tissue wall. Int J Periodontics RestorativeDeWitt GV, Dent.Cobb 1985; CM, 5:Killoy 38-51. WJ. The acute periodontal abscess: abscess was associated with subgingival calculus and periodontal 8. pocket. A diagnosis of periodontal abscess should be made after Periodontol. 2000; 27: 377-386. on overall evalution and interpretation of the patient’s chief Herrare D, Rolden S, Sonz M. The periodontal Abscess: A review. J Clin complaint, medical-dental history, and clinical and radiographic 9. examinations. Periodontal abscess can be treated with draining, 10. Hvan Xin Meng. Periodontal Abscess. Ann Periodontol. 1999; 4: 79-82. scaling-root planing, curettage and giving antibiotics, and routine to Periodontal Abscess: A retrospective study. J Periodontol. 1997; 68: Dwing E, Mc Leod, Phillip A. Lainson, James D. Spivey. Tooth Loss due surgical technics [5,8-12], as was showed in this case. 963-966. In conclusion, diagnosis and treatment of periodontal abscess 11. rationolized approach. Quintessence Int 1984; 15: 219-227. are mainly based an empiricism, since evidence-based data are Vence MG, Benfenati SP. Treatment of periodontal abscess: A not available. To maintaine periodontal health and to correct the 12. esthetics, their pathology should be treated. 311-312. Palmer RM. Acute lateral periodontal abscess. Br Dent J. 1984; 15: REFERENCES 1. 2004; 34: 204-216. Corbet EF. Diagnosis of acute periodontal lesions. Periodontol 2000. Cite this article Dilsiz A, Erdogan AS (2017) Therapy for a Patient with Periodontal Abscess: Case Report. JSM Dent Surg 2(3): 1021. JSM Dent Surg 2(3): 1021 (2017) 3/3.
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