Acute Abscess

The acute abscess is treated to alleviate symptoms, control the spread of infection, and establish
drainage. Before treatment, the patient’s medical history, dental history, and systemic condition
are reviewed and evaluated to assist in the diagnosis and to determine the need for systemic
antibiotics.

Drainage through Periodontal Pocket.

1. Anaesthesia. The peripheral area around the abscess with sufficient topical and local
anesthetic to ensure comfort.
2. The pocket wall is gently retracted with a periodontal probe or curette to initiate
drainage through the pocket entrance.
3. Gentle digital pressure and irrigation may be used to express exudates and clear the
pocket.
a. If the lesion is small and access uncomplicated, debridement in the form of
scaling and root planning may be undertaken.
b. If the lesion is large and drainage cannot be established, root debridement by
scaling and root planning or surgical access should be delayed until the major
clinical signs have abated.
4. Use of adjunctive systemic antibiotics with short-term high-dose regimens is
recommended.
5. Antibiotic therapy alone without subsequent drainage and subgingival scaling is
contraindicated.

Drainage through External Incision.

1. The abscess is dried and isolated with gauze sponges.

2. Topical anaesthetic is applied, followed by local anaesthetic injected peripheral to the lesion.
3. A vertical incision through the most fluctuant center of the abscess is made with a #15
surgical blade.
4. The tissue lateral to the incision can be separated with a curette or periosteal elevator.
5. Fluctuant matter is expressed, and the wound edges approximated under light digital
pressure with a moist gauze pad.
6. In abscesses presenting with severe swelling and inflammation, aggressive mechanical
instrumentation should be delayed in favour of antibiotic therapy to avoid damage to healthy
contiguous periodontal tissues.
7. Once bleeding and suppuration have ceased, the patient may be dismissed.
8. For those who do not need systemic antibiotics, posttreatment instructions include frequent
rinsing with warm salt water (1 tbsp/8-oz glass) and periodic application of chlorhexidine
gluconate either by rinsing or locally with a cotton-tipped applicator.
9. Reduced exertion and increased fluid intake are often recommended for patients showing
systemic involvement.
10. Analgesics may be prescribed for comfort. By the following day, the signs and symptoms
have usually subsided. If not, the patient is instructed to continue the previously
recommended regimen for an additional 24 hours. This often results in satisfactory healing,
and the lesion can be treated as a chronic abscess
Chronic Abscess

1. As with a periodontal pocket, the chronic abscess is usually treated with scaling and
root planing or surgical therapy.
2. Surgical treatment is suggested when deep vertical or furcation defects are encountered
that are beyond the therapeutic capabilities of nonsurgical instrumentation.
3. The patient should be advised of the possible postoperative sequelae usually associated
with periodontal nonsurgical and surgical procedures.
4. As with the acute abscess, antibiotic therapy may be indicated.

Gingival Abscess

Treatment of the gingival abscess is aimed at reversal of the acute phase and when applicable,
immediate removal of the cause.
1. To ensure procedural comfort, topical or local anesthesia by infiltration is administered.
2. When possible, scaling and root planing are completed to establish drainage and
remove microbial deposits.
3. In more acute situations the fluctuant area is incised with a #15 scalpel blade, and
exudate may be expressed by gentle digital pressure.
a. Any foreign material (e.g., dental floss, impression material) is removed.
b. The area is irrigated with warm water and covered with moist gauze under light
pressure.
c. Once bleeding has stopped, the patient is dismissed with instructions to rinse
with warm salt water every 2 hours for the remainder of the day.
d. After 24 hours the area is reassessed, and if resolution is sufficient, scaling not
previously completed is under-taken.
e. If the residual lesion is large or poorly accessible, surgical access may be
required.

Pericoronal Abscess

1. Acute pericoronal abscess is properly anesthetized for comfort

2. Drainage is established by gently lifting the soft tissue operculum with a periodontal
probe or curette.
a. If the underlying debris is easily accessible, it may be removed, followed by
gentle irrigation with sterile saline.
b. If there is regional swelling, lymphadenopathy, or systemic signs, systemic
antibiotics may be prescribed.
c. The patient is dismissed with instructions to rinse with warm salt water every 2
hours, and the area is reassessed after 24 hours.
d. If discomfort was one of the original complaints, appropriate analgesics should
be employed.
Once the acute phase has been controlled, the partially erupted tooth may be definitively treated
with either surgical excision of the overlying tissue or removal of the offending tooth.