How to differentiate between Acute Alveolar Abscess and Periodontal Abscess

Acute apical abscess is also known as Acute alveolar abscess which is the localized collection of pus in the alveolar bone at the root apex of the affected tooth. It is caused when the infection extends through the apical foramen into the peri-radicular tissue. Periodontal Abscess is caused due to impaction of foreign body in the Gums leading to an abscess. It is different from Acute apical periodontitis as the infection is passed into the periodontium through the root canal. Let us look at all the differences between Acute Alveolar Abscess and Periodontal Abscess.

Acute apical abscess is most commonly caused due to necrotic pulp tissue leading to the bacteria invading the periapical tissue, the other reasons can be chemical or mechanical injury to the pulp leading to its necrosis or spread of a Gingival or periodontal lesion into the pulpal tissue (Perio-Endo lesion). It is different from Alveolar abscess in time taken for the lesion to form along with its association with chronic periodontitis leading to abscess formation.

Type of Pain:

  • Acute Alveolar Abscess: Continuous, pulsating (replicating heart beat) or Pounding type
  • Periodontal Abscess: Dull constant

Time of Pain:

  • Acute Alveolar Abscess: Pain intensity increases at night or while lying down
  • Periodontal Abscess: No change in pain with posture or time

Pain felt on:

  • Acute Alveolar Abscess: Affected tooth can be localized easily on percussion
  • Periodontal Abscess: Pain can be felt only on probing and multiple teeth show TOP (tenderness on percussion)

Mobility of tooth:

  • Acute Alveolar Abscess: Yes
  • Periodontal Abscess: Seen in severe cases where one or more teeth re mobile

Response to Pulp Vitality Tests:

  • Acute Alveolar Abscess: EPT: No response, Cold: No response, Heat: No response
  • Periodontal Abscess: EPT: No response, Cold: Normal, Heat: Normal

Swelling:

  • Acute Alveolar Abscess: Yes, significant appearance
  • Periodontal Abscess: Seen only in severe cases

Radiographic appearance:

  • Acute Alveolar Abscess: Affected tooth has caries or failed restoration or fracture leading to infection
  • Periodontal Abscess: Foreign body in the gingival tissue might be seen along with vertical bone loss

Treatment:

  • Acute Alveolar Abscess: Drainage of Abscess by giving an incision followed by Antibiotics and NSAID’s. This should be followed by either Root Canal therapy or Extraction of the affected tooth as per the tooth prognosis.
  • Periodontal Abscess: Removal of foreign body from the gums, Complete scaling and Curettage of the infected part

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