|Year : 2016 | Volume
| Issue : 4 | Page : 134-139
Retrospective evaluation of the clinical management of patients with periodontal abscesses attending a teaching hospital
Modupeoluwa Omotunde Soroye1, Clement Chinedu Azodo2
1 Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
2 Department of Periodontics, School of Dentistry, University of Benin, Benin City, Edo State, Nigeria
|Date of Web Publication||13-Feb-2017|
Modupeoluwa Omotunde Soroye
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State
Source of Support: None, Conflict of Interest: None
Aim: This study aimed to examine the clinical management of patients who attended a Nigerian teaching hospital with periodontal abscesses. Setting and Design: This is a retrospective study among patients who attended the Periodontics Clinic of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria, between January 2008 and December 2015. Patients and Methods: Information about the diagnosis was obtained from the departmental log book, and case notes were retrieved from record department. Data collection elicited information on age, sex, tribe, frequency of tooth brushing, dental attendance, medical history, clinical features, involved tooth/teeth, and treatment received. Statistical Analysis Used: Epi info version 3.5.1 was used for statistical analysis. Results: Patients aged between 15 and 87 years, with a mean age of 35.53 ± 19.30 years. Majority of patients were males, had minor ethnic extractions, had some form of education, first dental clinic attendees, indulged in once-daily toothbrushing, fully dentate, and had fair/poor oral hygiene. A total of 8.8% and 31.6% of the participants smoked cigarettes and consumed alcohol, respectively. A fifth of the participants had systemic diseases such as hypertension, diabetes mellitus, and peptic ulcer disease. Majority of the participants (91.2%) had severe pain. About two-fifths had periodontal abscess around the incisors and the molars. The upper right quadrant was mostly involved (31.6%). Two-fifth of the patients had extraction done. Conclusion: Data from this study revealed periodontal abscess as a severely painful condition in naÏve dental patients, successfully treated mainly through extraction of the implicated tooth/teeth. This implies that oral health awareness and regular dental attendance may prevent its occurrence.
Keywords: Periodontal abscess, systemic disease, treatment received
|How to cite this article:|
Soroye MO, Azodo CC. Retrospective evaluation of the clinical management of patients with periodontal abscesses attending a teaching hospital. J Dent Res Rev 2016;3:134-9
|How to cite this URL:|
Soroye MO, Azodo CC. Retrospective evaluation of the clinical management of patients with periodontal abscesses attending a teaching hospital. J Dent Res Rev [serial online] 2016 [cited 2020 Feb 23];3:134-9. Available from: http://www.jdrr.org/text.asp?2016/3/4/134/200013
| Introduction|| |
Alocalized purulent infection of the periodontal tissues is referred to as periodontal abscess. Periodontal abscess occurs around the roots of the teeth just below the gingival tissue and is usually associated with bone and connective tissue loss but may result in bacteremia with consequent infections in distant locations if untreated or poorly treated.,,, It is a prevalent clinical finding among patients with untreated moderate-to-severe periodontitis.,
Hence, a proposed classification of periodontal abscess depending on its relation to periodontal pockets was postulated. If unrelated to periodontitis, foreign body impaction and radicular abnormalities are the main causes. While if related to periodontitis, the condition may appear as an exacerbation of an untreated periodontitis or occur during the course of periodontal therapy. Changes in subgingival microflora and/or decreased host resistance have been reported as the precipitating factors for periodontal abscesses resulting from preexisting chronic periodontitis. Another classification of periodontal abscess into acute and chronic forms is based on the onset and pattern of presentation. The most recent classification of periodontal abscess was depicted in 1999 International Classification of Periodontal Diseases as gingival, periodontal, and pericoronal abscesses based on the location.
Periodontal abscess is usually associated with swelling, redness, suppuration, loosening, and extrusion of the involved tooth/teeth and tenderness to slight percussion. Occasionally, there may be a slight increase in temperature and other constitutional symptoms., Some of the etiological factors associated with the formation of acute periodontal abscesses include occlusion of pocket orifices, furcation involvement, systemic antibiotic treatment, and diabetes mellitus (DM). Patients with advanced periodontal disease given systemic antibiotic therapy without subgingival debridement may change the composition of the subgingival microbiota, thus favoring the outburst of multiple periodontal abscesses.
The organisms associated with periodontal abscesses are similar to those found in chronic periodontitis. They are mainly Gram-negative anaerobic organism and those found in high frequencies are usually Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, and Capnocytophaga spp.,,, Strains of Peptostreptococcus, Streptococcus milleri (Streptococcus anginosus and Staphylococcus intermedius), Bacteroides capillosus, Veillonella, Bacteroides fragilis, and Eikenella corrodens have also been isolated. Microbiological assessment of sites of periodontal abscess after treatment reported the disappearance of P. gingivalis from them, suggesting a close association of this microorganism with abscess formation.
Pain relief and control of infection are usually the initial management with extraction or retention of the involved tooth/teeth as a strategically important decision. Extraction is advocated if there is a history of recurrent periodontal abscesses. Periodontal abscess has been reported as one of the main causes of tooth loss among patients undergoing maintenance periodontal treatment.,, Other recommended treatments for periodontal abscess are scaling and root planing, incision and drainage, use of mouthwash, use of antibiotics as a preventive measure against systemic diseases, and in the presence of systemic symptoms. The burden of periodontal abscess necessitates the need for evaluation of risk factors and rendered care toward offering cost-effective evidence-based preventive and curative periodontal treatment. The objective of this study was to examine the clinical management of patients who attended a Nigerian teaching hospital with periodontal abscesses.
| Patients and Methods|| |
This retrospective study was carried out among patients who attended the Periodontics Clinic of the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria, between January 2008 and December 2015. The initial information about the diagnosis was obtained from the departmental log book. After the index cases were obtained, their case notes were subsequently retrieved from record department. Data collection tool was a data capture form which elicited information on age, sex, tribe, level of education, alcohol consumption, tobacco use, daily toothbrushing frequency, oral hygiene status, dental attendance and treatment history, medical history, pain characteristics, clinical features, status of dentition, involved tooth/teeth, and treatment rendered. Data analysis was done using Epi info version 3.5.1. Statistical significance was set at P < 0.05.
| Results|| |
A total of 68 cases were retrieved from the departmental log book. Sixty-four of the 68 patients who presented with abscesses had periodontal abscess while the other four had gingival abscess. Only 57 cases were retrieved from the record department and used for this study. Age ranged between 15 and 87 years, with a mean age of 35.53 ± 19.30 years. There were more males (54.4%) than females (45.6%). The majority of the participants came from minority tribal groups in Nigeria such as Ikwerre, Ogoni, Calabar, and Akwa Ibom. About three-quarters of the participants had some form of education [Table 1]. [Table 2] reveals that 8.8% and 31.6% of the participants smoke cigarettes and consume alcohol, respectively. Only four (7%) participants brushed their teeth twice daily. Three-fifths of them had a fair oral hygiene, while two-fifths had a poor oral hygiene. Only one (1.8%) participant had a good oral hygiene [Table 3].
|Table 3: Toothbrushing habit and oral hygiene status among the participants|
Click here to view
Participants' dental visit history showed that only two-fifths of them visited the dentist in the past majorly for tooth extraction and scaling and polishing [Table 4]. A fifth of the participants had systemic diseases such as hypertension (HPT), DM, and peptic ulcer disease. The predominant systemic disease was HPT [Table 5]. The participants' periodontal abscess pain profile showed that majority (91.2%) of them had pain associated with the periodontal abscesses. Pain was mild in 5 (9.6%), moderate in 18 (34.6%), and severe in 29 (55.8%) patients. Pain was more spontaneous (57.7%) than intermittent (42.3%). Four-fifth of the participants had non-radiating pain. The majority (84.6%) of the participants had pain while chewing. Analgesics such as paracetamol and antibiotics such as amoxil and flagyl relieved the associated pain in half of the participants who had pain [Table 6]. Only 7 of the 57 participants who constituted 12.3% presented with associated periodontal pockets. There were suppuration and mobility in 49 (86%) and 14 (24.6%) participants, respectively. Only one (1.8%) participant presented with gingival abscess. One-fifth of the participants were partially edentulous [Table 7]. About two-fifths of the participants had periodontal abscess around the incisors and the molars. The upper right quadrant was mostly involved (31.6%) followed by the left lower quadrant (22.8%). Two-fifths of the participants had extraction done. They were also placed on medication [Table 8].
|Table 8: Teeth and quadrants affected by periodontal abscess and treatment received|
Click here to view
| Discussion|| |
This study set to examine the clinical management of patients with periodontal abscess which found a higher male preponderance among the patients, which was similar to findings in another study  but contrasted to the one done by Gray et al. This can be accounted for by the fact that older participants were involved in their study. The mean age of the patients in this study was 35.53 ± 19.30 years which is lower than 50.88 ± 17.73 years reported in a similar study in Benin City, Nigeria. In this study, the highest prevalence of periodontal abscess was found among the younger age group (21-30 year olds) and this may explain why a few proportion of the participants had periodontitis-associated periodontal abscess. Also this may be related to the presence of high-risk factors among the patients in terms of tobacco use, alcohol consumption, frequency of teeth cleaning, poor dental attendance, and fair/poor oral hygiene status.
The majority of the periodontal abscess in the study was acute periodontal abscess based on the presence of pain. The pain was mainly severe, spontaneous, non-radiating in nature, associated with masticatory disturbance, and rarely disturbing sleep but temporarily relieved by drugs. Other features included suppuration and tooth mobility.
Lack of dental visit and tooth loss, especially due to extraction, indicate poor oral health awareness in an individual. In this study, about two-third of the participants (65.4%) never visited the dentists and most of those who did attended between 2 and 5 years ago and had tooth extraction. Thus, in this study, about one-fifth of the patients were partially edentulous. This confirms the highest prevalence of periodontal abscess in untreated patients.
Systemic diseases modify periodontal disease and treatment. In this study, 15.8% of the participants had systemic diseases and more than half (55.6%) of them had HPT. Although this finding agrees with the study  done in Benin City, Nigeria, which reported a high prevalence of HPT among its participants, it also highlights the importance of medical history in periodontology that will facilitate optimal care devoid of complications.
In this study, the incisors and the molars were the teeth implicated in periodontal abscess formation. This is in contrast with a study done by Gray et al. which reported a lower rate involvement of the maxillary incisors and first premolars. Azodo and Umoh  recorded the highest prevalence of periodontal abscess in the molars (64%). This may be linked to the less dominance of periodontitis-associated periodontal abscess in this study.
If periodontal abscess is not treated adequately, it can result in the spread of infection to the surrounding facial tissues and eventual tooth loss., The treatment of periodontal abscess is in two phases; the initial therapy and definitive therapy. The initial therapy consists of drainage through pocket retraction or incision, scaling and root planing, periodontal surgery, systemic antibiotics, and/or tooth removal. Definitive treatment which is done according to the treatment needs of the patient involves the reassessment of the initial therapy to restore the function and esthetics and to enable the patient to maintain the health of the periodontium. In this study, 35% of the participants had extraction while only 5.3% had incision and drainage, which confirms periodontal abscess as a major periodontal reason for tooth loss. Azodo and Umoh reported that 32% of their participants had incision and drainage. The preference of tooth extraction may be related to their previous experience as nearly one-fifth of the participants were partially edentulous.
| Conclusion|| |
Data from this study revealed periodontal abscess as a severely painful condition in naïve dental patients, successfully treated mainly through extraction of the implicated tooth/teeth. This implies that oral health awareness and regular dental attendance may prevent the occurrence of the periodontal abscess.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Meng HX. Periodontal abscess. Ann Periodontol 1999;4:79-83.
Gallagher DM, Erickson K, Hollin SA. Fatal brain abscess following periodontal therapy: A case report. Mt Sinai J Med 1981;48:158-60.
Chan CH, McGurk M. Cervical necrotising fasciitis – A rare complication of periodontal disease. Br Dent J 1997;183:293-6.
Waldman BJ, Mont MA, Hungerford DS. Total knee arthroplasty infections associated with dental procedures. Clin Orthop Relat Res 1997;343:164-72.
Suzuki JB, Delisle AL. Pulmonary actinomycosis of periodontal origin. J Periodontol 1984;55:581-4.
Corbet EF. Diagnosis of acute periodontal lesions. Periodontol 2000 2004;34:204-16.
Herrera D, Roldán S, Sanz M. The periodontal abscess: A review. J Clin Periodontol 2000;27:377-86.
Silva GL, Soares RV, Zenóbio EG. Periodontal abscess during supportive periodontal therapy: A review of the literature. J Contemp Dent Pract 2008;9:82-91.
Azodo CC, Umoh AO. Periodontal abscess among patients attending a Nigerian specialist periodontology clinic. Trop J Med Res 2016;19:24-8.
Armitage CG. Development of a Classification System for Periodontal Diseases and Conditions. Annals of periodontology 1999;4:1-6.
Ahl DR, Hilgeman JL, Snyder JD. Periodontal emergencies. Dent Clin North Am 1986;30:459-72.
Smith RG, Davies RM. Acute lateral periodontal abscesses. Br Dent J 1986;161:176-8.
Topoll HH, Lange DE, Müller RF. Multiple periodontal abscesses after systemic antibiotic therapy. J Clin Periodontol 1990;17:268-72.
Hafström CA, Wikström MB, Renvert SN, Dahlén GG. Effect of treatment on some periodontopathogens and their antibody levels in periodontal abscesses. J Periodontol 1994;65:1022-8.
van Winkelhoff AJ, van Steenbergen TJ, de Graaff J. The role of black-pigmented Bacteroides
in human oral infections. J Clin Periodontol 1988;15:145-55.
Aitken S, Birek P, Kulkarni GV, Lee WL, McCulloch CA. Serial doxycycline and metronidazole in prevention of recurrent periodontitis in high-risk patients. J Periodontol 1992;63:87-92.
Kulkarni GV, Lee WK, Aitken A, Birek P, McCulloch CA. A randomized, placebo-controlled trial of doxycycline: Effect on the microflora of recurrent periodontitis lesions in high risk patients. J Periodontol 1991;62:197-202.
Chen CM. Bacteriological investigation of anaerobes in 11 cases of periodontal abscess and methods to improve its detection rate. Chinese Journal of Stomatology 1983;18:209-11.
Chace R Sr., Low SB. Survival characteristics of periodontally-involved teeth: A 40-year study. J Periodontol 1993;64:701-5.
McLeod DE, Lainson PA, Spivey JD. Tooth loss due to periodontal abscess: A retrospective study. J Periodontol 1997;68:963-6.
Becker W, Berg L, Becker BE. The long term evaluation of periodontal treatment and maintenance in 95 patients. Int J Periodontics Restorative Dent 1984;4:54-71.
Vályi P, Gorzó I. Periodontal abscess: Etiology, diagnosis and treatment. Fogorv Sz 2004;97:151-5.
Gray JL, Flanary DB, Newell DH. The prevalence of periodontal abscess. J Indiana Dent Assoc 1994;73:18-20, 22-3.
Medeiros R Jr., Catunda Ide S, Queiroz IV, de Morais HH, Leao JC, Gueiros LA. Cervicofacial necrotizing fasciitis following periodontal abscess. Gen Dent 2012;60:316-21.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]