Abscess of the gums: the more dangerous, the consequences, the autopsy

Periodontal (periodontal) abscess - or, more simply, gum abscess - is the formation in periodontal tissue of a cavity filled with purulent contents. The focus of inflammation is localized in the area near the tooth and has the appearance of a small formation inside the gum. Abscess is always very painful and delivers a great degree of discomfort to the patient.

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Epidemiology

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

There is no exact information on the number of gum disease abscesses per 100,000 population.

[2], [3], [4],

Causes of the abscess of the gum

The main cause of the abscess is bacteria that penetrate the periodontal pocket. To get there microbes can be in the presence of certain factors.

Local risk factors:

• reactions of inflammation inside the gums and in the marginal periodontal region (for example, periodontitis, gingivitis);
• traumatic damage to the gums during dental treatment, during meals, during brushing, etc .;
• perforation of the tooth wall during removal of the nerve;
• damage associated with malocclusion;
• a stressful habit of gnashing his teeth.

Systemic risk factors:

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

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Pathogenesis

The most frequent inflammatory reaction inside the gums is caused by a staphylococcal pathogen. Less common are its combinations with other microbes.

The causative agent can get into tissues from the outside, or with a current of blood or lymph from other parts of the body. For example, the most common infections are infection with stomatitis, gingivitis, with mucous injuries, after injections of anesthetics, etc.

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

Next, a granulation is formed in the form of a membrane that localizes the abscess. If the walls of the abscess are still bursting, then a spilled inflammatory reaction develops.

If the process changes its course from acute to chronic, an opening in the tissues can be formed - a fistula that undergoes scarring as a result of the proliferation process.

[6], [7]

Symptoms of the abscess of the gum

Gum abscess is difficult to confuse 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 development of the inflammatory process:

• there is acute pain when touched by an inflamed area;
• chew and take food becomes unbearable;
• you can visually see a small swelling in the form of a ball inside the gums.

With the progression of the process, the symptoms change:

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

With the growth of the abscess of the gum, the patient feels worse, there is pain in the head, nausea, the temperature rises, insomnia appears and appetite disappears.

Sometimes purulent abscess of the gum is revealed by itself, and immediately after that the patient feels a sudden relief. Many people mistakenly believe that after that the trip to the doctor can be canceled, since the disease recedes. This is not so: the remains of pus that did not come out of the cavity, but remained in the tissues, can provoke a relapse of the abscess of the gum, as well as the transformation of the acute course of the inflammatory process into a chronic one. If this happens, the treatment will be longer and more difficult, up to an operational intervention.

Stages

1. The stage of infiltration is characterized by the appearance of a dense section of the gum, on which there are signs of an inflammatory process (redness, swelling, soreness).
2. The stage of abscessing is characterized by the appearance on the spot of a seal (infiltrate) of a cavity with purulent contents.

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Forms

Abscesses of the gums may occur in the following variants:

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

In addition, the abscess is divided between the surface and the deep, depending on the depth of its location.

Complications and consequences

Complications of abscess gums appear in such situations:

• if the abscess is not treated, or treated improperly;
• at operative opening of an abscess of a gum or gingiva.

If the abscess is not treated properly, the infectious process can spread to neighboring tissues. In addition, healthy teeth may loosen and even fall out.

The more serious condition - the complication of the abscess - is phlegmonous inflammation, which is a pathological process with the defeat of all closely located healthy tissues. Phlegmon is treated quite hard, treatment is only in the hospital.

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

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Diagnostics of the abscess of the gum

In most cases, the doctor can diagnose immediately after the examination of the patient. Additional diagnostic procedures may be needed to clarify the severity, depth, cause of the abscess, and to assess the likelihood of complications.

Inspection of the oral cavity of the patient can be accompanied by palpation of the nearest lymph nodes, an evaluation of the muscular tension of the maxillofacial region. Also, the doctor palpates the gum, determines the painful area, checks it for bleeding and purulent discharge. With the help of tools, the mobility and shakiness of the teeth is checked.

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

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

• X-ray of the affected jaw;
• ultrasonography;
• CT scan;
• Magnetic resonance imaging.

[13], [14], [15]

Differential diagnosis

Differential diagnostics is carried out with gingivitis (gum disease without violation of the dento-dental connection), periodontitis (periodontal inflammation with increasing destruction), periodontitis (dystrophic periodontal lesions), periodontomes (epulis, fibromatosis, etc.).

Treatment of the abscess of the gum

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

• severity of the inflammatory process;
• the degree of tooth damage in the area of the abscess;
• previous treatment.

The standard treatment consists in the operative opening of the inflamed focus with the removal of purulent contents from the cavity. In this case, the cavity itself is carefully cleaned and rinsed with an antiseptic solution.

For early recovery, the doctor will prescribe medications and physiotherapy procedures, as well as give advice on the subsequent care for the painful gum area.

The opening of the abscess of the gum lies in the incision of the compacted area (capsule), the removal of purulent contents and dead tissues, the installation of drainage for the residual excretion of pus, and also in washing the cavity of the capsule with antiseptic liquids. The autopsy is performed under local anesthesia: it is for this reason that it is not recommended before taking any strong painkillers before the procedure.

Medications are prescribed taking into account the resistance of microorganisms, the severity of the inflammatory process and other individual factors. What drugs are preferred - the doctor decides in each case. However, the following medicines may become most popular:

• Metrogil Denta is applied a small layer on the area of the affected gum 2-3 times a day, for a week. After the gel is applied, you can not eat and drink for about half an hour. If you accidentally swallow the gel, you may experience nausea, dizziness, and headache.
• Aseptal gel based on propolis is used similarly to the previous preparation. Sometimes this product can cause an allergic reaction.
• Holisal - dental gel - is used topically as an anesthetic, up to 3 times a day. A gel band 10 mm in length is rubbed softly into the affected area of the mucosa. The application of the gel can sometimes be accompanied by a burning sensation that passes by itself and does not require the withdrawal of treatment.
• Kamistad gel based on chamomile is used to rub into the gums three times a day. The drug can cause allergies, so the first time it should be used with caution.

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

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

Most often, the doctor stops the choice of such antibiotics:

• amoxiclav - take 1 tablet. Every 8-12 hours, for 5-14 days;
• sumamed - ingest 500 mg per day, for 3 days;
• augmentin - taken for 1-2 weeks, 1 tablet three times a day;
• amoxicillin - injected intramuscularly 1 g twice a day;
• linkomycin - take 0.5 g to 4 times a day, or as intramuscular injections of 0.6 g to 2 times a day;
• clarithromycin - for internal administration, the dosage is 0.25 to 1 g twice daily;
• kanamycin - injected or taken orally, 0.5-1 g;
• azithromycin - take inside 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 for 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 abscess of the gum.

Vitamins

In order to relieve inflammation in gum abscess, the doctor will prescribe serious medications - these can be antibiotics, antiseptic and anti-inflammatory drugs, analgesics, etc. The treatment scheme can be expanded by adding vitamin complexes to it - thus wound healing will go much faster and quality.

Unambiguous benefit with abscess gums will bring:

• vitamins of group B;
• ascorbic acid, vitamins A, E, PP;
• additional trace elements 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 nutrients without taking complex preparations, by expanding the diet. In this case, the daily menu necessarily includes vegetable components, oils, dairy products.

Physiotherapeutic treatment

Physiotherapeutic procedures are used to anesthetize and eliminate inflammation in the gums, stimulate tissue repair and strengthen local immunity.

With gum abscess, you can use these procedures:

• ultrasonic irradiation;
• US-therapy;
• ultraphonophoresis;
• laser treatment;
• magnetotherapy.

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

For a short period of time, the activity of inflammation can be reduced by magnetotherapy. In addition, this procedure potentiates the effectiveness of drugs that are used by the application method.

Alternative treatment

In any case, alternative treatment should not be a substitute for traditional medical care. However, as a first aid, or after a surgical autopsy along with conventional medicines, alternative prescriptions may be helpful.

• Dissolve in 200 ml of warm water 1 tsp. Baking soda, mix and use to rinse your mouth every 1-1.5 hours, and after every meal.
• Prepare a 10-minute decoction from the bark of oak (1 tablespoon bark for 250 ml of water), cool it to a warm state and use it to rinse your mouth - at least 5 times a day.
• Cut the lower leaf of the aloe plant, rinse it and squeeze out the juice. We use this juice, digging it in a few drops on the inflammation site on the gum (three times a day).
• We buy in the pharmacy the oil extract of chlorophyllipt. Lubricate them with the affected area of the gum, or apply to the abscess vatka, moistened with extract, for 15-20 minutes, several times a day.

In addition, you can use a variety of herbal recipes based on medicinal plants.

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Herbal Treatment

• One teaspoon of spirit tincture of marigolds is diluted in 250 ml of water. The resulting solution is used to rinse the mouth up to 5 times a day.
• We steal 1 tbsp. L. Sage in 250 ml of boiling water, we insist for 50-60 minutes, we filter and apply for rinses.
• We tear off several leaves of plantain, rinse and thoroughly chew. Swallow cake is not necessary, it is important that the juice of the plant hit the wound - after chewing 5-10 minutes, it can be spit.
• We brew black strong tea with the addition of 1 tsp. Herbs of St. John's wort - such a herbal combination tea has "tannic" abilities and well soothes inflamed gums. The drink is used for rinsing, although taking it inside is also not less useful.

The proposed recipes are really very effective. However, one should not hope that the abscess will pass by itself, without any treatment. Therefore, in any case with a gum abscess, a doctor's consultation should be mandatory.

Homeopathy

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

Use homeopathic remedies instead of traditional treatment should not.

• Aconite in breeding 6 will help calm the inflammatory process, eliminate redness and numbness of the gums.
• Apis in breeding 6 will relieve the pain in the gums, reduce the swelling.
• Belladonna 6 will help cope with inflammation, dry mucous, and also eliminate a viscous coating on the surface of the tongue and palate.
• Mercurius solubilis in breeding 12 will remove swelling, eliminate the unpleasant aftertaste and smell from the mouth, stop bleeding from the gums.
• Nux vomica in breeding 6 restores tissue after a purulent inflammatory process, removes the plaque on the mucosa and reduces swelling.

When choosing homeopathic remedies, one must pay attention to the severity of their anti-inflammatory action. The doctor-homeopath appoints the dosage of the listed preparations individually, considering the features 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 norms and needs of the body. So, the diet should contain a sufficient amount of ascorbic acid and calcium - to strengthen the gums and teeth. Such substances can be found in greenery, dairy products, marine fish, fruits and nuts.
• It is undesirable to abuse alcohol, to smoke. A healthy lifestyle is a guarantee of good skin and mucous membranes.
• Regularly and daily it is necessary to monitor the hygiene of the teeth and oral mucosa. It is important to use not only a toothbrush twice a day, but also a dental floss - to clean the interdental cracks.

In addition, you should visit your dentist regularly, even if you have no problems with your teeth: this is done for prevention, in order to prevent inflammation, which the patient himself can not pay attention to.

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Forecast

Gum abscess can be successfully cured by promptly contacting a doctor. If you do not contact the doctor, hoping that the pus on its own leaves the inflammatory focus, you can "earn" a number of complications, which significantly worsens the further prognosis of the disease.

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