October 15, 2022
Human teeth are enveloped by a complex of hard and soft tissues that contribute to their normal functioning. These tissues are the gums, the tissue covering the roots (cementum), the underlying bone (alveolar bone) and the ligament connecting the tooth to the bone (periodontal ligament). The complex of these four tissue structures is called the periodontium.
How does the infection happen in the first place?
An infection in a tooth can spread by two routes. It can either begin as a carious lesion and spread till the roots and underlying bone from within the tooth. The other route involves pathogenic microbes invading the space between gums and the tooth and reaching the deeper tissues. Poor oral hygiene welcomes the harmful microorganisms that thrive in acididc environment which is also due to improper eating habits.
When an infection develops within the deeper areas of the tooth or surrounding structures, it manifests itself as a swelling. This swelling contains infectious fluid that can further spread to adjacent tissues and invade them. This is called an abscess.
An abscess can be of two types depending on where it is formed. If it occurs at he margin of the gums near the tooth, it is called a gingival abscess. If it forms in the deeper areas of the surrounding tooth structure it is called periodontal abscess.
A gum or gingival abscess can be one or more in number. Patients with systemic conditions like diabetes mellitus or on antibiotic treatment for non-oral diseases often present with gingival abscess. If untreated, it can spread deeper to the underlying bone.
Clinical presentation of gum abscess
When a patient complains of gingival abscess, a dentist takes a radiograph to understand the nature of the infection. In most cases, severe calculus or impaction by a foreign object within the gingiva is the main cause of gum abscess.
A gingival abscess can be tender and be painful upon touch. A radiograph helps determining the extent of the infection, whether or not it has spread into the deeper tissues. Gingival abscesses occurr because of the formation of pockets. These pockets are a result of the loss of attachment of marginal gingiva to the tooth. The pockets get filled with microbes that do the damage.
In cases of gingival abscess, an obstruction caused by a foreign body is the most common reason for the subsequent swelling. Some patients may also complain of a fluid discharge from the affected tooth.
Treatment for gum blisters (gum abscess)
Gingival abscesses are corrected by removing the obstruction that is causing the inflammation. Debriding calculus in that region if present is the first step for correcting gingival abscess. If the cause is not calculus but an impacting object, than it is removed subgingivally by a currette. This is followed by subgingival scaling or cleaning of the affected tooth.
A dentist will perform all these procedure by giving a local anesthesia in the affected region. If a foreign body or calculus is not the reason of the gingival abscess, then the radiograph is inspected for any infection within the tooth or at its roots. In such cases, a root canal treatment may be required.
Whether or not the tooth is infected, draining the abscess is mandatory. After giving a local anesthesia, the dentist will make a small incision in the most fluctuant area of the abscess that will drain the infectious fluid. Once it is drained and the bleeding is controlled, the patient is prescribed some antimicrobial drugs.
Post-operatively, patients are advised to increase fluid intake for faster healing. Warm salt water rinses are also recommended. A follow-up after three days gives the dentist an idea of how effective the treatment plan was.
Some gingival abscesses are caused because of self-injurious habits like nail-biting, chewing pointed objects, improper or overzealous usage of toothpicks, etc. These should be evaluated and considered during history taking.
Gingival abscesses usually have a favorable prognosis. However, when a patient presents with multiple and recurrent gingival abscesses, then the patient should be assessed for any systemic conditions or more severe oral conditions like carcinomas or neoplasms.
Patient is educated about maintaining proper and consistent oral hygiene techniques. They are also advised to stop smoking and educated on how it can interfere with the healing of the gingival abscess. Gingival abscesses should never be neglected and should be managed upon immediate diagnosis.