How to identify oral abscess

Gingival and Periodontal Abscesses

For the diagnosis of periodontal abscess, inspection and examination by periodontal probe (to identify edema/gingival erythema, periodontal pockets and bone defects) and a radiographic image confirming the decrease in bone height, are usually sufficient. However, when the clinical features are not accompanied by periodontal disease and there is a history of trauma or impaction, gingival abscess is usually diagnosed [3]. Pericoronitis is an infection that is associated with an erupting tooth, especially the third molar. The mucosa covering the tooth becomes inflamed, with a traumatism caused by the opposing teeth and infection caused by food remnants under the mucosal layer. The pain is intense, and is usually associated with submandibular adenitis, sore throat, trismus and fever [7]. The treatment of gingival/periodontal abscess aims to achieve drainage of the purulent collection, either through an incision in the fluctuant area or through the periodontal pocket. In cases of periodontal abscess, root debridement is usually required, along with antibiotic and analgesic treatment [3, 7].

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review. © 2018 Miranda-Rius et al. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Clinical examination

Starting with an extra-oral examination, the clinician can assess for the presence of facial swelling or asymmetry, being mindful of the potential for systemic spread of dental infection (eg cellulitis); although, such cases are thankfully uncommon. Critical indicators of systemic involvement include pyrexia and difficulty swallowing or breathing, which may signify airway restriction that requires urgent hospital referral. Additionally, palpation of the temporomandibular joint (TMJ) and lymph nodes is essential. TMJ dysfunction should be ruled out in cases of pain, which may mimic endodontic issues. The intra-oral examination aims to identify the potential causes of the patient's symptoms. It begins with assessing the patient's general dental hygiene status and examining the oral soft tissues. It is the responsibility of any clinician who examines the patient to be able to identify and report abnormalities. Dental professionals should be vigilant in recognising soft tissue irregularities and arrange for further investigation or referral when needed.

Endodontic assessment, complexity, diagnosis and treatment planning. © The Author(s) 2025. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Gingival and Periodontal Abscesses

Gingival abscesses, which appear in the gingival sulcus, are comparatively rare. Periodontal abscesses usually occur in areas with periodontal pockets, in which deep spaces are generated around the teeth. They cause a dull, gnawing, localized pain but are not painful to percussion. The discomfort ranges from low intensity aches to severe acute pain. Periodontal abscesses may be tender to lateral periodontal pressure and the pain in the tooth adjacent to the injury usually worsens with chewing. Gingival abscesses are usually located in the marginal interdental tissue. Both gingival and periodontal abscesses present localized reddening of the gingivae, which may include the alveolar mucosa. Injuries are fluctuant, violaceous, cyanotic or erythematous and may be accompanied by a fistula [3].

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review. © 2018 Miranda-Rius et al. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).