How does periodontal abscess come about?

Periodontal abscess is also a type of periodontitis, which is mainly caused by severe purulent inflammation of periodontal tissues. Periodontitis is also divided into chronic periodontitis abscess and acute periodontitis abscess. Patients with periodontal abscess will have obvious pain, which will be affected in their daily meals. Therefore, periodontal surgery or abscess removal is generally chosen for the treatment of periodontal abscess. Rinsing your mouth with light salt water every day can prevent periodontal abscesses or periodontitis.

Periodontal abscess is not an independent disease, but a common complication of periodontitis developing to the late stage with the appearance of deep periodontal pockets. It is a localized suppurative inflammation located in the periodontal pocket wall or deep periodontal tissue, which can cause destruction of the surrounding collagen fibers and bone. According to the location of the abscess, it is divided into periodontal abscess and gingival abscess. Depending on the course of the disease, it is divided into acute and chronic periodontal abscess. Based on the number, periodontal abscesses are divided into single and multiple.

Causes

Purulent inflammation (30%):

When the purulent inflammation on the inner wall of a deep periodontal pocket extends to the deep connective tissue and the pus cannot be discharged into the pocket, an abscess may form in the soft tissue of the pocket wall. In tortuous deep periodontal pockets involving multiple tooth surfaces, the purulent exudate cannot be drained smoothly, especially when the root bifurcation area is involved.

Scaling or scraping (25%):

Rough movements during cleaning or scaling may push tartar fragments and bacteria into the deep tissue of the periodontal pocket or damage the gingival tissue; incomplete scaling of deep periodontal pockets may cause the pocket opening to shrink, but the inflammation at the bottom of the pocket still exists and is not drained.

Endodontic treatment (20%):

Lateral perforation of the root canal or pulp chamber floor, longitudinal root fractures, etc. during endodontic treatment can sometimes cause periodontal abscesses.

Systemic diseases (15%):

Periodontal abscess is more likely to occur when the body's resistance is reduced or there are serious systemic diseases, such as diabetes. Patients with multiple or recurrent periodontal abscesses should be careful to exclude the possibility of diabetes.

Microorganisms (5%):

Some highly virulent periodontal pathogens colonize and proliferate in the periodontal pockets, aggravating and spreading the infection.

Pathological changes

There are a large number of living or necrotic neutrophils accumulated in the periodontal pocket wall. Necrotic white blood cells release a variety of proteolytic enzymes, causing the surrounding cells and tissues to necrotize and dissolve, forming pus in the center of the abscess. There is an acute inflammatory area around the abscess, the surface epithelium is highly edematous, and a large number of white blood cells enter the epithelium.