Editors

Veli-JukkaUitto

Emergency Treatment of a Gingival Abscess

Abscesses may occur either on the buccal or lingual side of the row of teeth. An abscess in the gingival region can be caused by:
- an acute inflammation in the dental pulp (see pulpitis and its complications First Aid for Severe Dental Pain).
- an inflammation in a deep periodontal pocket.
A general practitioner may initiate antimicrobial therapy.
If the patient has general symptoms like fever and general feeling of malaise and/or fatigue, difficulties in swallowing or opening the mouth, or swelling of the neck, or if the patient is at high risk of infection he/she should be referred to a hospital.
A dentist should then remove the infective tissue or bacterial plaque with curettes.

The infective bacteria and the infectious discharge cause increased pressure in the tissues. The pressure is usually relieved through a fistula that is formed through the jawbone and the overlying soft tissues.
Before the fistula is formed the tooth is often sensitive to heat because an increase in the temperature further increases the pressure in the dental pulp cavity. Sensitivity to cold on the other hand suggests that the pulp may be inflamed but is still viable.

The acute phase is treated with penicillin V, in patients at increased risk of infection with amoxicillin or with combination of amoxicillin and metronidazole.
- Patients allergic to penicillin are treated with cephalexin or clindamycin instead of penicillin.
Healing of a gingival abscess caused by an infection of the dental pulp requires careful removal of the infected tissue from the pulp cavity. The treatment is carried out by a dentist through root canal therapy.

In periodontitis bacterial deposits grow down along the root surface ever deeper under the gingiva. At the same time the root attachment is destroyed due to the inflammatory process.
An abscess may develop in the gingiva. In due course, it will empty spontaneously through a fistula.

Antimicrobial therapy may temporarily soothe a gingival abscess. Abscesses from deep gingival pockets seem to respond particularly well to orally administered metronidazole (400 mg twice a day).
The antimicrobial drug does not, however, eliminate permanently the cause of the inflammation, i.e. the bacterial growth within the biofilm on the deep root surfaces. This is removed by root scaling under local anaesthesia.
The patient should take particularly good care of his/her oral hygiene in order to avoid relapse of the abscess.