Gingival abscess

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Risk factors

  • Include diabetes, smoking, certain periodontal bacteria, aging, gender, genetic predisposition, systemic diseases and conditions (immunosuppression), stress, nutrition, pregnancy, HIV infection, substance abuse and medications

Clinical features

  • Inflammation of the gingiva and periodontium
  • Loss of periodontal ligament attachment
  • Red and slightly swollen gums with obvious pus accumulation
  • Bleeding on slight provocation

Treatment goals

  • Drainage to relieve the acute symptoms and mitigation of the aetiology
  • Periodontal abscess-
  • Establishing drainage by debriding the pocket and removing plaque, calculus, and other irritants and/or incising the abscess
  • Other treatments may include irrigation of the pocket, limited occlusal adjustment, and administration of antimicrobials and management of patient comfort
  • A surgical procedure for access for debridement may be considered. In some circumstances extraction of the tooth may be necessary
  • A comprehensive periodontal evaluation should follow resolution of the acute condition

Non-drug treatment

  • Instruction, reinforcement, and evaluation of the patient's plaque control should be performed
  • Supra- and subgingival scaling and root planning should be performed to remove microbial plaque and calculi

Drug treatment

  • Analgesics
    • Paracetamol
    • Adult: 1 g orally every 8 hours for 3-5 days
    • Child:
      • 1-5 years: 125-250 mg every 8 hours for 3-5 days,
      • 6-12 years: 250-500 mg every 8 hours for 3-5 days
  • Antibiotics
    • Amoxicillin
    • Adult: 250 mg orally every 8 hours for 5 days
    • Child:
      • 1 month - 1 year 62.5 mg orally every 8 hours; dose doubled in severe infections
      • 1-5 years: 125 mg every 8 hours for 5 days
      • 5-12 years: 250 mg 8 hourly for 5 days
      • 12-18 years 500 mg 8 hourly for 5 days; all doses doubled in severe infections
    • Metronidazole
    • Adult: 200 mg orally every 8 hours for 5 days
    • Child:
      • 1-3 years 50 mg orally every 8 hours for 5 days
      • 3-7 years:100 mg every 12 hours for 5 days
      • 7-10 years: 100 mg every 8 hours for 5 days
  • Antiseptic mouthwashes:
    • Chlorhexidine gluconate 2% three times daily for 1- 2 weeks
    • Hexetidine mouthwashes to alternate with warm saline mouthwashes