Gingival abscess: what is dangerous, consequences, dissection

A periodontal (periodontal) abscess – or, more simply, a gum abscess – is the formation of a cavity filled with purulent contents in the periodontal tissue. The inflammation is localized in the area next to the tooth and looks like a small formation inside the gum. The abscess is always very painful and causes a great deal of discomfort to the patient.

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Epidemiology

According to statistics, the frequency of detection of gum abscess is inversely proportional to the quality of life of patients and oral hygiene. In the male population, abscess is more severe than in women.

There is no exact information on the number of cases of gum abscess per 100 thousand population.

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Causes gingival abscess

The main cause of an abscess is bacteria that penetrate into the periodontal pocket. Microbes can get there if certain factors are present.

Local risk factors:

• inflammatory reactions inside the gum and in the area of the marginal periodontium (eg, periodontitis, gingivitis);
• traumatic injury to the gums during dental treatment, while eating, while brushing teeth, etc.;
• perforation of the tooth wall during nerve removal;
• damage associated with malocclusion;
• stress-related habit of grinding teeth.

Systemic risk factors:

• endocrine system diseases;
• weak immunity;
• stress for the body - for example, hypothermia or overheating.

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Pathogenesis

Most often, the inflammatory reaction inside the gum is caused by a staphylococcal pathogen. Less common are its combinations with other microbes.

The pathogen can enter the tissues from the outside, or with the blood or lymph flow from other parts of the body. For example, the most common penetrations of infection are stomatitis, gingivitis, mucosal injuries, after anesthetic injections, etc.

The formation of an abscess itself begins with the appearance of proteolytic enzymes at the site of the inflammatory process. They melt the dying tissues and residual elements of cell decomposition, which leads to the formation of purulent contents.

Next, granulation is formed in the form of a shell that localizes the abscess. If the walls of the abscess still rupture, then a diffuse inflammatory reaction develops.

If the process changes its course from acute to chronic, then an opening in the tissues may form - a fistula, which, as a result of the proliferation process, undergoes scarring.

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Symptoms gingival abscess

It is difficult to confuse a gum abscess with any other disease, due to the characteristic features of the clinical picture. Thus, the first signs of an abscess are detected already at the initial stage of the inflammatory process:

• there is acute pain when touching the inflamed area;
• chewing and eating food becomes unbearable;
• Visually, you can see a small swelling in the form of a ball inside the gum.

As the process progresses, the symptoms change:

• the tooth next to the abscess may feel loose when touched;
• purulent contents begin to be released from the abscess;
• The abscess increases in size to such an extent that the patient's facial contours change.

As the gum abscess grows, the patient feels worse and worse, headaches and nausea appear, the temperature rises, insomnia occurs, and appetite disappears.

Sometimes a purulent gum abscess opens on its own, and immediately after that the patient feels a sudden relief. Many people mistakenly believe that after this, a visit to the doctor can be canceled, since the disease recedes. This is not true: the remnants of pus that did not come out of the cavity, but remained in the tissues, can provoke a relapse of the gum abscess, as well as the transformation of the acute inflammatory process into a chronic one. If this happens, the treatment will be longer and more complicated, up to and including surgical intervention.

Stages

1. The infiltration stage is characterized by the appearance of a dense area of the gum, which shows signs of an inflammatory process (redness, swelling, pain).
2. The abscess formation stage is characterized by the appearance of a cavity with purulent contents at the site of the compaction (infiltrate).

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Forms

Gum abscesses can occur in the following ways:

• in the form of a cold abscess (without signs of an inflammatory process, including without redness of the gums and without an increase in temperature);
• in the form of a post-injection abscess (the appearance of an abscess after an injection into the gum).

In addition, a distinction is made between superficial and deep abscesses, depending on the depth of their location.

Complications and consequences

Complications of gum abscess occur in the following situations:

• if the abscess is not treated or is treated incorrectly;
• during surgical opening of a gum abscess.

If the abscess is not treated properly, the infection can spread to adjacent tissues. In addition, healthy teeth can become loose and even fall out.

A more severe condition – a complication of an abscess – is phlegmonous inflammation, which is a pathological process with damage to all nearby healthy tissues. Phlegmon is quite difficult to treat, treatment is carried out only in a hospital.

Complications during surgical opening of an abscess may occur with large sizes of the inflammatory focus or with weak immunity of the patient. In this case, the abscess may be complicated by bleeding and repeated development of the inflammatory reaction.

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Diagnostics gingival abscess

In the vast majority of cases, the doctor is able to make a diagnosis immediately after examining the patient. Additional diagnostic procedures may be needed to clarify the severity, depth, cause of the abscess, as well as to assess the likelihood of complications.

Examination of the patient's oral cavity may be accompanied by palpation of the nearest lymph nodes, assessment of muscle tension in the maxillofacial area. The doctor also palpates the gum, determines the painful area, checks it for bleeding and purulent discharge. The mobility and looseness of the teeth are checked with the help of instruments.

Blood tests will help the doctor confirm the presence of an inflammatory process: usually a shift in the formula to the left, an increase in the level of leukocytes and an acceleration of the ESR are detected.

To clarify the location and size of the gum abscess, instrumental diagnostics are prescribed:

• X-ray of the affected jaw;
• ultrasound examination;
• computed tomography;
• magnetic resonance imaging.

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Differential diagnosis

Differential diagnostics are carried out with gingivitis (inflammation of the gums without disruption of the gingival-dental junction), periodontitis (inflammation of the periodontium with its increasing destruction), periodontosis (dystrophic lesion of the periodontium), periodontomas (epulis, fibromatosis, etc.).

Treatment gingival abscess

The treatment plan for a gum abscess is determined by the doctor depending on:

• the severity of the inflammatory process;
• the degree of damage to the teeth in the area of the abscess;
• previously conducted treatment.

Standard treatment involves surgically opening the inflamed area and removing purulent contents from the cavity. The cavity itself is carefully cleaned and washed with an antiseptic solution.

To ensure a speedy recovery, your doctor will prescribe medications and physical therapy procedures, and will also give advice on subsequent care of the painful gum area.

Opening a gum abscess involves cutting the compacted area (capsule), removing purulent contents and dead tissue, installing drainage for residual pus removal, and rinsing the capsule cavity with antiseptic fluids. Opening is performed under local anesthesia: for this reason, it is not recommended to take any strong painkillers before the procedure.

Medicines are prescribed taking into account the resistance of microorganisms, the severity of the inflammatory process and other individual factors. Which drugs are preferable - the doctor decides in each specific case. However, the following medications may be the most in demand:

• Metrogyl Denta is applied in a thin layer to the affected gum area 2-3 times a day for a week. After the gel is applied, you cannot eat or drink for about half an hour. If the gel is accidentally swallowed, nausea, dizziness and headache may occur.
• Asepta gel based on propolis is used similarly to the previous drug. Sometimes this product can cause an allergic reaction.
• Holisal is a dental gel that is used locally as an anesthetic, up to 3 times a day. A 10 mm long strip of gel is rubbed into the affected area of the mucous membrane with gentle movements. The application of the gel can sometimes be accompanied by a burning sensation, which goes away on its own and does not require discontinuing treatment.
• Kamistad chamomile gel is used for rubbing into the gums three times a day. The drug can cause allergies, so it should be used with caution for the first time.

Antibiotics for gum abscess can be prescribed in tablets or injections:

• Glycosamides.
• Fluoroquinolone antibiotics.
• Antibiotics of the penicillin group.

Most often, the doctor chooses the following antibiotics:

• amoxiclav - take 1 tablet every 8-12 hours for 5-14 days;
• sumamed - taken orally at 500 mg per day for 3 days;
• Augmentin - taken for 1-2 weeks, 1 tablet three times a day;
• amoxicillin - administered by intramuscular injection at 1 g twice a day;
• lincomycin - taken 0.5 g up to 4 times a day, or in the form of intramuscular injections of 0.6 g up to 2 times a day;
• clarithromycin - for internal use, the dosage is from 0.25 to 1 g twice a day;
• kanamycin - administered by injection or taken orally, 0.5-1 g;
• azithromycin – taken orally from 0.25 to 1 g daily for 3-5 days.

The listed drugs are considered quite effective, but they all have a whole list of side effects. For this reason, their independent use can be dangerous to the health of the body. Only a doctor can accurately determine the average daily dose, taking into account the age, weight of the patient, and the severity of the gum abscess.

Vitamins

In order to relieve inflammation in a gum abscess, the doctor will definitely prescribe serious medications - these can be antibiotics, antiseptic and anti-inflammatory drugs, analgesics, etc. The treatment regimen can be expanded by adding vitamin complexes to it - this way the wound will heal much faster and better.

The following will definitely be beneficial for gum abscess:

• B vitamins;
• ascorbic acid, vitamins A, E, PP;
• additional microelements in the form of calcium, magnesium, iron and selenium.

Doses and specific drugs are selected individually, as the doctor takes into account the severity of the abscess, its size, the presence of complications, as well as the age and general health of the patient. In uncomplicated cases, it is possible to obtain vitamins and other useful substances without taking complex drugs, by expanding the diet. In this case, the daily menu must include plant components, oils, dairy products.

Physiotherapy treatment

Physiotherapeutic procedures are used to relieve pain and eliminate inflammation in the gums, stimulate tissue regeneration and strengthen local immunity.

For gum abscess, the following procedures can be used:

• ultrasonic irradiation;
• Ultrasound therapy;
• ultraphonophoresis;
• laser treatment;
• magnetic therapy.

Often doctors prefer not local physiotherapeutic effects, but general procedures to strengthen the immune defense and improve the body's immune response to the introduction of infection. For example, if a gum abscess develops again, it is recommended to conduct general ultraviolet irradiation, with repeated irradiation after six months. Also, in case of recurrent course, electrophoresis with magnesium and ultrasound therapy will be useful.

Magnetic therapy can reduce inflammation activity in a short period of time. In addition, this procedure potentiates the effectiveness of medications that are used by the application method.

Folk remedies

Folk remedies should never replace traditional medical care. However, as first aid, or after surgical opening, along with conventional medications, folk recipes may come in handy.

• Dissolve 1 teaspoon of baking soda in 200 ml of warm water, stir and use to rinse your mouth every 1-1.5 hours, as well as after each meal.
• Prepare a 10-minute decoction of oak bark (1 tbsp. bark per 250 ml of water), cool to warm and use to rinse your mouth – at least 5 times a day.
• We cut off the lower leaf of the aloe plant, wash it and squeeze out the juice. We use this juice, putting a few drops of it on the inflammation site on the gum (three times a day).
• We buy oil extract of chlorophyllipt in the pharmacy. We lubricate the affected area of the gum with it, or apply a cotton wool soaked in the extract to the abscess for 15-20 minutes, several times a day.

In addition, you can use various herbal recipes based on medicinal plants.

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Herbal treatment

• Dilute one teaspoon of marigold alcohol tincture in 250 ml of water. Use the resulting solution to rinse your mouth up to 5 times a day.
• Steam 1 tbsp. of sage in 250 ml of boiling water, leave for 50-60 minutes, filter and use for rinsing.
• We tear off several plantain leaves, wash them and chew them thoroughly. There is no need to swallow the pulp, it is important that the juice of the plant gets on the wound - after chewing for 5-10 minutes, you can spit it out.
• Brew strong black tea with 1 teaspoon of St. John's wort - this herbal combination tea has "tanning" properties and soothes inflamed gums well. Use the drink for rinsing, although taking it internally is no less useful.

The suggested recipes are really very effective. However, you should not hope that the abscess will go away on its own, without any treatment. Therefore, in any case, with a gum abscess, a doctor's consultation should be mandatory.

Homeopathy

Homeopathic remedies can only be used when the gum abscess has been opened and the doctor has prescribed anti-inflammatory treatment. In this case, homeopathy will help speed up recovery and tissue healing.

Homeopathic remedies should not be used in place of traditional treatment.

• Aconite in a dilution of 6 will help to calm the inflammatory process, eliminate redness and numbness of the gums.
• Apis in a dilution of 6 will relieve gum pain and reduce swelling.
• Belladonna 6 will help to cope with inflammation, dryness of the mucous membrane, and will also eliminate sticky plaque on the surface of the tongue and palate.
• Mercurius solubilis in a 12 dilution will relieve swelling, eliminate unpleasant taste and odor from the mouth, and stop bleeding from the gums.
• Nux vomica in a dilution of 6 restores tissue after a purulent inflammatory process, removes plaque on the mucous membrane and reduces swelling.

When choosing homeopathic remedies, you need to pay attention to the severity of their anti-inflammatory effect. The dosage of the listed drugs is prescribed by a homeopathic doctor individually, taking into account the characteristics of the course of the disease in a particular patient.

Prevention

In order to reduce the possibility of developing an abscess to a minimum, it is necessary to pay attention to the following recommendations:

• Human nutrition must meet all the standards and needs of the body. Thus, the diet must contain a sufficient amount of ascorbic acid and calcium - to strengthen the gums and teeth. Such substances can be found in greens, dairy products, sea fish, fruits and nuts.
• It is not advisable to abuse alcohol or smoke. A healthy lifestyle is the key to good skin and mucous membranes.
• Regularly and daily, it is necessary to monitor the hygiene of teeth and oral mucosa. It is important to use not only a toothbrush twice a day, but also dental floss - to clean the spaces between the teeth.

In addition, you should visit your dentist regularly, even if you have no dental problems: this is done for prevention, to prevent inflammatory processes that the patient himself cannot pay attention to.

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Forecast

A gum abscess can be successfully treated by contacting a doctor in a timely manner. If you do not contact a doctor, hoping that the pus will come out of the inflammatory focus on its own, you can “earn” a number of complications, which significantly worsens the further prognosis of the disease.

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