Editing Toothache (section)

=====Periodontal abscess=====
[[File:Cracked tooth lateral periodontal abscess.jpg|thumb|right|Lateral periodontal abscess (blue arrows) due to a fracture (green arrows)]]
A [[periodontal abscess]] (lateral abscess) is a collection of pus that forms in the [[gingival sulcus|gingival crevice]]s, usually as a result of chronic periodontitis where the pockets are pathologically deepened greater than 3mm. A healthy gingival pocket will contain bacteria and some [[calculus (dental)|calculus]] kept in check by the [[immune system]]. As the pocket deepens, the balance is disrupted, and an acute inflammatory response results, forming pus. The debris and swelling then disrupt the normal flow of fluids into and out of the pocket, rapidly accelerating the inflammatory cycle.  Larger pockets also have a greater likelihood of collecting food debris, creating additional sources of infection.<ref name="Carranza11th"/>{{rp|443}}

Periodontal abscesses are less common than apical abscesses, but are still frequent.  The key difference between the two is that the pulp of the tooth tends to be alive, and will respond normally to pulp tests. However, an untreated periodontal abscess may still cause the pulp to die if it reaches the tooth apex in a [[periodontic-endodontic lesion]]. A periodontal abscess can occur as the result of tooth fracture, food packing into a periodontal pocket (with poorly shaped fillings), calculus build-up, and lowered immune responses (such as in [[diabetes]]).  Periodontal abscess can also occur after periodontal scaling, which causes the gums to tighten around the teeth and trap debris in the pocket.<ref name="Carranza11th"/>{{rp|444–445}} Toothache caused by a periodontal abscess is generally deep and throbbing. The [[oral mucosa]] covering an early periodontal abscess appears [[erythema]]tous (red), [[Swelling (medical)|swollen]], shiny, and [[hyperalgesia|painful to touch]].<ref name="AAP2000">{{cite journal | title=Parameter on acute periodontal diseases. | author=American Academy of Periodontology | journal=J Periodontol |date=May 2000 | volume=71 | issue=5 | pages=863–6 | pmid=10875694 | doi=10.1902/jop.2000.71.5-S.863| doi-access=free }}</ref>

A variant of the periodontal abscess is the gingival abscess, which is limited to the gingival margin, has a quicker onset, and is typically caused by trauma from items such as a fishbone, toothpick, or toothbrush, rather than chronic periodontitis.<ref name="Carranza11th"/>{{rp|446–447}} The treatment of a periodontal abscess is similar to the management of dental abscesses in general (see: [[Toothache#Treatment|Treatment]]).  However, since the tooth is typically alive, there is no difficulty in accessing the source of infection and, therefore, antibiotics are more routinely used in conjunction with [[scaling and root planing]].<ref name="herrera2002">{{cite journal|title=A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients.|journal=Journal of Clinical Periodontology|year=2002|volume=29|pages=136–59; discussion 160–2|pmid=12787214|vauthors=Herrera D, Sanz M, Jepsen S, Needleman I, Roldán S |issue=Suppl 3 |doi=10.1034/j.1600-051X.29.s3.8.x}}</ref> The occurrence of a periodontal abscess usually indicates advanced periodontal disease, which requires correct management to prevent recurrent abscesses, including daily cleaning below the gumline to prevent the buildup of subgingival [[Dental plaque|plaque]] and calculus.