LETTER TO EDITOR
Year : 2012 | Volume
: 2 | Issue : 1 | Page : 55--56
Department of Periodontics, Manipal College of Dental Sciences, Manipal University, Karnataka, India
Department of Periodontics, Manipal College of Dental Sciences, Manipal University, Karnataka
|How to cite this article:|
Varghese J. Periodontal abscess.J Interdiscip Dentistry 2012;2:55-56
|How to cite this URL:|
Varghese J. Periodontal abscess. J Interdiscip Dentistry [serial online] 2012 [cited 2019 Jul 23 ];2:55-56
Available from: http://www.jidonline.com/text.asp?2012/2/1/55/94200
I read with keen interest the case report entitled "Multiple periodontal abscesses due to clenching" authored by Gurumoorthy et al.,  which was published in your esteemed journal. I appreciate the author's aptitude to report such unique contributory factors causing periodontal disease. However, I would like to highlight some of my queries regarding this particular case report and its management.
The duration of clenching, was it a habit or was it just an event due to the nightmare experience?What was the periodontal condition in the rest of the oral cavity, as the author has focused narration only on the area of interest (region 34 to 37).What were the medical tests conducted to rule out the patient's systemic profile (since there were multiple periodontal abscesses)?Intraoral examination of the site 34 to 37 revealed only soft tissue changes? What about the hard tissue changes? Were there any occlusal wear facets or chipped enamel seen in any of the affected teeth (34 to 37) considering the immense soft tissue alterations?Was the integrity of the occlusion assessed during the examination? Were there any new restorations or high-fillings or prosthesis? This should be done to rule out acute trauma from occlusion.[Figure 2] depicting the intraoral examination is not very clear and shows a slough in the left buccal vestibular region. Was there any history of chemical burns?Did the author set a differential diagnosis prior to confirming the final diagnosis?Also, I feel that as part of the treatment regimen, an occlusal grinding should have been performed. This would have aided during the healing phase.
Clenching is a continuous or intermittent closure of jaws prominent under pressure. These habits (bruxism, clenching) represent perversions of occlusion that are potentially injurious to the periodontal tissues, masticatory muscles and the temporo-mandibular joint. The reasons for clenching could be categorized as emotional, habitual or mechanical; emotional cause being at the top of the list for clenching.  A literature review on this topic proposed that excessive clenching leading to an abscess is less familiar. However, the patient with a clenching habit can damage one or several teeth until the tissue can no longer repair itself. There will be alveolar bone destruction around the tooth increasing the width of the periodontal ligament space. The tooth will exhibit mobility. The tissue around the tooth may become necrotic and infected. The patient would clench his teeth creating pain and swelling of the tissues around the affected tooth or teeth. The excessive pressure against the periodontal membrane and the periapical tissues causes the tissue to respond by swelling.
As per the Textbook of Periodontology by Carranza,  an acute abscess is often an exacerbation of a chronic inflammatory periodontal lesion. The influencing factors include increased number and virulence of bacteria present combined with lowered tissue resistance and lack of spontaneous drainage.
|1||Gurumoorthy K, Ajjappa B, Prakash S. Multiple acute periodontal abscess due to clenching. J Int Dent 2011;1:37-40.|
|2||Glickman I. Food impaction, habits and other local factors. Clinical Periodontology, prevention, diagnosis and treatment of periodontal disease in practice of general dentistry, 4 th ed, Philadelphia: W.B. Saunders Co; 1973. p. 332.|
|3||Newman M, Takei H, Klokkevold, Carranza F. Treatment of Periodontal abscess. In: Melnick and Takei, Editors. Carranza's Clinical Periodontology, 10 th ed, Philadelphia: Saunders and Elseivers Co.; 2005. p. 715.|