Inflammation or disease of the teeth is very common, but patients often do not notice it until it is too late. Important nerve pathways can be affected. And abscesses and inflammatory diseases in the head area can quickly reach the brain or develop blood poisoning. Abscesses, including periodontal abscesses, are not uncommon. These are often dismissed as harmless pimples without recognizing the dangerous nature of these inflammations.
What is a periodontal abscess?
A periodontal abscess, also known as a gum pocket abscess, is an abscess that develops in the tooth area. An abscess is a cavity filled with pus that becomes encapsulated in killed tissue. Since this encapsulation prevents the pus from draining away, the abscess persists for a long time and can also spread to healthy neighboring tissue. In some cases, the pus can also spill into the bloodstream and cause sepsis (blood poisoning). Unlike acne pimples, abscesses are more extensive and the cavities created are filled with dead tissue. Abscesses around the mouth are dangerous because this area has numerous nerves and blood vessels.
Causes
An abscess is caused by bacteria. Especially in the oral cavity, small infections can easily occur, as this area comes into contact with many bacteria. Insufficient oral hygiene can support this process. The bacteria inflame the gums, but also internal areas of the tooth as well as the bone. The tissue dies and encapsulates itself from the surrounding area. As a result, a pocket or cavity is formed. The abscess cannot recede because the pus inside cannot escape. It is possible for small valves to form, but this rarely happens. As the bacterially contaminated pus drains away, the main risk is that neighboring tissues may become infected or spill into other areas of the oral cavity and inflame them. Puncturing the abscess is therefore not advisable. If the abscess is not treated, it will spread and become larger. The dead tissue is stored inside the abscess until it has a chance to pour into other tissue cavities or outward. If a bloodstream is reached, the abscess pours into it. This leads to life-threatening blood poisoning.
Symptoms, complaints, and signs
A periodontal abscess begins as a small redness and swelling. Over the course of a few hours, a small pimple forms and then grows larger. This is accompanied by increasing tooth pain as the abscess spreads to the tooth itself. The gums become very red and bulge out. As the disease progresses, a pus-filled pocket forms, which, unlike an acne pimple, does not simply break open. In some cases, however, the abscess may develop below, at the root of the tooth, and not be detected by the patient. The tooth begins to degenerate – in everyday life it is referred to as a “rotten tooth”. The abscess interrupts the blood supply to the tooth. Intense pain is the result. Other direct consequences are tooth loosening and even tooth loss. The entire region feels painful to the patient. Other symptoms may include fever and general fatigue and exhaustion. The quality of life can suffer considerably if the patient can hardly eat. Social contacts can also suffer from the disease if bad breath develops as a result of the abscess. If the symptoms have been ignored for a long time, secondary abscesses may form.
Diagnosis and course of the disease
A dentist can easily detect a periodontal abscess. Even the external observation of the tooth area, swelling and possibly gum disintegration are indications of this disease. To prevent subsequent damage to the bone area, the dentist will also take an x-ray of the area to assess the exact course of the abscess. The radiograph will provide an accurate picture of the pus progression. If the disease has progressed for some time, the doctor will also examine the blood count. In this way, it can be determined whether the bacteria have already entered the bloodstream. An abscess is relatively easy to treat so that the course of the disease does not progress. After treatment, the symptoms disappear after a few days.
Complications
Periodontal abscesses occur frequently and are usually the result of small injuries in the mouth area in combination with inadequate oral and dental hygiene. Larger abscesses must definitely be treated by a dentist. In case of professional therapy the abscesses heal again without serious complications. However, these disorders can become dangerous if the affected person ignores them, treats them himself or seeks medical help much too late. If the abscess is not treated properly, it usually grows larger and larger. The dead tissue accumulates in the abscess capsule until it finally bursts and the capsule contents spill into the surrounding tissue or bloodstream. The latter can be very dangerous, as the pathogens can thus reach and infect not only the adjacent mouth and throat area, but also other organs. In this case, there is a risk of severe blood poisoning, which can be life-threatening for the patient. The risk of the pathogens infecting the surrounding tissue also exists when the dentist opens the abscess. However, it is much lower in a controlled procedure under hygienic conditions than in an uncontrolled breakthrough. Under no circumstances should the pus collection be lanced by the patient himself. Moreover, if the abscess is treated too late, this inflammation can lead to the destruction of the periodontal tissue, resulting in tooth loss.
When should you go to the doctor?
Redness and swelling in the mouth are signs of disease. A visit to the doctor is necessary as soon as the irregularities persist or there is an increase in symptoms. A doctor should be consulted if there are disturbances during tooth cleaning or food intake, or problems with an existing denture. Pain, discomfort and a feeling of illness should be examined and treated. If deformities or distortions of the face are noticed or if there is a feeling of tightness in the mouth, consultation with a physician is advised. Fatigue, exhaustion or sleep disturbances are further indications for which action is required. A disturbance of concentration or attention as well as a reduced performance capacity should be discussed with a doctor. Loosening of the teeth or tooth loss should be presented to a doctor as soon as possible. A refusal to eat, loss of appetite, weight loss or bad breath are indications of a health impairment. A visit to the doctor should take place so that a diagnosis can be made and steps towards treatment can be taken. Fever, an increased need for sleep or headaches are complaints that frequently occur in patients with a periodontal abscess. If a feeling of pressure in the mouth or throat sets in or if hypersensitivity reactions occur, a physician is needed. A decreased sense of well-being, inner restlessness, and irritation in the jaw area should be evaluated by a physician.
Treatment and therapy
Treatment of a periodontal abscess must be performed by a physician. Lancing of the abscess by the patient will not eliminate the disease, but may lead to blood poisoning in the worst case. Treatment is given after the abscess has been positively identified. The treatment can be done under local anesthesia. The dentist will open the abscess and drain the pus. He will then remove the dead tissue. The tissue is not sutured, because with the help of antibacterial inserts the bacteria are killed. The dentist must perform this treatment several times to ensure no flare-ups. Gums heal very quickly, which helps the healing process. During the treatment, the dentist will also investigate other causes of the abscess. For example, a decayed tooth or even an inflamed root can cause the abscess. Consequential damage will also be repaired during treatment. The abscess may have severely damaged the tooth or its surroundings. In the worst case, the tooth must be extracted. The treatment can be done on an outpatient basis. If the bacteria have spread, the patient will be hospitalized. The patient will then receive antibacterial infusions, such as penicillin. Consequential damage is not expected if treated in time. However, periodontal abscesses may recur at a later stage.
Outlook and prognosis
With good and prompt medical care, the prognosis of periodontal abscess is favorable. The affected area is professionally opened by a doctor. Subsequently, the fluid that has formed in the abscess is aspirated. If the procedure proceeds without further complications, complete freedom from symptoms is achieved within a few days or weeks. Without medical treatment, various disorders and adverse health effects may occur. The pathogens can spread further in the organism and cause consequential damage. Teeth, the gums as well as the root of the surrounding teeth can be affected by further diseases. In particularly severe cases, the affected person is threatened with blood poisoning and thus the risk of premature death is increased. Pus can enter the bloodstream and lead to the life-threatening development within a short time. Likewise, there is a possibility that the surrounding area may become further inflamed and ultimately lead to the loss of the tooth. In addition to the medical intervention, a drug therapy is initiated in a subsequent treatment for the fastest possible healing. The administration of medication promotes the wound healing process and prevents existing pathogens and germs from spreading. It should be noted that people with a weakened immune system may experience delays in the recovery process.
Prevention
Prevention is difficult. Periodontal abscess is caused by bacteria. A healthy oral flora as well as a healthy immune system help prevent infection.
Aftercare
In periodontal abscess, consistent aftercare is very important, as it is also prevention of possible recurrence. Regular and thorough brushing is the basis of optimal oral hygiene. This includes not only correct brushing technique and toothbrush. It is important to clean the fine interdental spaces with dental floss or interdental brushes, as this is an optimal nesting place for the bacteria that can trigger the periodontal abscess. However, brushing teeth is not enough in the aftercare of periodontal abscesses, because even good brushing does not reach all regions in the mouth. Therefore, regular professional dental cleaning (PZR) is part of the aftercare. Here, trained prophylaxis assistants perform a thorough cleaning that also covers areas that are not reached by conventional brushing. In addition to the interdental spaces, the gum line is also the main focus here. PZR removes hard plaque (the classic tartar) as well as soft plaque (the biofilm) and reduces the bacteria that are usually responsible for the formation of an abscess. In addition, during the aftercare period, it is also best to avoid smoking and drinking too much alcohol. In addition, during meals, care should be taken to chew thoroughly, as this stimulates saliva production, which can also have a positive influence with regard to the development of bacterial processes.
What you can do yourself
It is important that the patient has the periodontal abscess treated immediately by a dentist. This is the only way to avoid secondary diseases such as tooth loss or infection. If the patient goes to the doctor too late, the abscess may rupture and cause blood poisoning. Under no circumstances should the patient treat the periodontal abscess himself, for example by lancing it. This should only be done under sterile, controlled conditions at the doctor’s office. To prevent the wound from becoming infected again and to prevent a further abscess, the patient should pay more attention to his oral and dental hygiene in the future. The dentist treating the patient can provide appropriate advice. The patient should avoid nicotine at all costs during this time, as it interferes with the healing process of the oral mucosa. Other stimulants such as alcohol or coffee also irritate the oral mucosa unnecessarily. It is possible that an inflamed root or a decayed tooth was the trigger for the periodontal abscess. This leads to follow-up treatments at the dentist, which must be strictly adhered to, otherwise the disease will recur. A periodontal abscess affects the whole body. The patient may have been tired, fatigued and feverish during the illness, all signs of an overworked immune system. Now is the time to support the immune system with a healthy lifestyle.This includes regular meals with a high fruit and vegetable content as well as a regulated sleep-wake rhythm.
