Periodontal abscesses and periapical abscesses are two different diseases that need to be differentiated. Periapical abscesses, arising from endodontic issues, can be very painful and usually respond well to endodontic treatment. Periodontal abscesses on the other hand are not very painful. Let me summarize some of the characteristics of the two different types of abscesses.
Characteristics
Periodontal Abscess
- Dull, constant, localized pain:
- Not very painful to percussion test
- Patient is able to locate the offending tooth
- Tooth may or may not be vital
- Deep probing depth
Periapical Abscess (endodontic)
- Severe, sharp, intermittent and diffuse pain
- Very painful to percussion test
- Patient is not always able to locate the offending tooth
- Tooth is non-vital
- Probing depth can be shallow or deep (narrow if deep)
- Pain at the apex of the tooth upon palpation
Treatment
Periapical abscess
- endodontic treatment
Periodontal abscess
- incision and drainage
- no aggressive debridement, remove foreign object if present (especially if it is an acute abscess)
- antibiotics if systemic symptoms are present (fever, malaise, etc.)
- treatment plan after the abscess has been resolved
- If deep probing depth persists with rough root surfaces, scaling & root planing will be needed
Most chronic periodontal abscesses arise from existing deep pockets. When these chronic abscesses have been resolved, the site may be treated as chronic periodontitis. In acute periodontal abscesses, you should not root plane the involved area since you might be destroying the potential for regeneration in the involved area.