Gingival abscesses tend to involve the marginal gingiva and result from entrapment of food and plaque debris and subsequent staphylococcal, streptococcal, anaerobic, or mixed bacterial overgrowth. Localized swelling, erythema, tenderness, and fluctuance in the space between the tooth and gingiva ensue. There may be spontaneous purulent drainage from the gingival margin, or an area of abscess pointing. When the gingival abscess involves the deeper supporting periodontal structures, referred to as a periodontal abscess, the patient may present with a fluctuant vestibular abscess or with a draining sinus that opens onto the gingival surface.
In contrast, periapical abscesses are deep and not obvious on inspection. They usually present as tenderness to percussion or pain with chewing over the involved tooth. A parulis may also simulate a gingival abscess; however, a parulis represents the cutaneous manifestation of a deeper periapical abscess. Unlike a parulis or periapical abscess, gingival abscesses are not usually associated with dental caries or fillings. Pericoronal abscesses tend to involve the gingiva overlying a partially erupted 3rd molar.
Management and Disposition
The initial management is, after topical anesthesia, to create a small incision and irrigate with saline. Oral antibiotic therapy, analgesics, and dental follow-up are indicated. The patient’s tetanus status should be addressed.
Patients with gingival abscesses are usually afebrile. Consider more extensive abscess formation and oral disease processes in the febrile toxic-appearing patient.
Patients with chronic, deep periodontal abscesses complain of dull, gnawing pain as well as a desire to bite down on and grind the tooth.
Periodontal Abscess. Localized gingival swelling, erythema, and fluctuance are seen in this periodontal abscess with spontaneous purulent drainage. (Photo contributor: Kevin J. Knoop, MD, MS.)