I need only landmark and important study articles with key contribution related to Question : Abscess in periodontology to mention in my study notes for university theory exam question.
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periodontal abscess microbiology etiology pathogenesis
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"periodontal abscess" classification 2018 new classification
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"periodontal abscess" Herrera 2018 workshop acute periodontal conditions
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Herrera abscesses periodontium 2018 world workshop classification
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"periodontal abscess" treatment drainage antibiotics outcome
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abscesses periodontium Herrera Sanz classification acute conditions 2018
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"periodontal abscess" microbiology Gram negative anaerobes Fusobacterium Prevotella
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Herrera 2018 "abscesses in the periodontium" World Workshop J Clin Periodontol PMID
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"periodontal abscess" treatment systemic antibiotics amoxicillin metronidazole randomized
I now have all the landmark studies needed. Let me compile a comprehensive, well-structured answer for exam study notes.
Here is a structured list of landmark and important studies on abscesses in periodontology, organized by theme, with key contributions clearly noted. These are the articles most frequently cited in periodontal textbooks and exam syllabi.
Landmark Studies: Abscess in Periodontology
1. Classification & Comprehensive Review
Herrera D, Roldán S, Sanz M. (2000)
"The periodontal abscess: a review."
J Clin Periodontol. 27(6):377-86. PMID: 10883866
Key Contribution - THE foundational review article. Established that:
- Periodontal abscess is the 3rd most frequent dental emergency
- Two main etiological groups: periodontitis-related (exacerbation of untreated disease or during therapy) vs. non-periodontitis related (foreign body impaction, radicular abnormalities)
- Microflora is dominated by Gram-negative anaerobic rods, similar to adult periodontitis
- Possible spread of infection to distant body sites
- Role of systemic antibiotics remains controversial (empirical, not evidence-based at the time)
2. The 2018 World Workshop - Current Gold Standard Classification
Herrera D, Retamal-Valdes B, Alonso B, Feres M. (2018)
"Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions."
J Periodontol. 89(Suppl 1):S85-S102. / J Clin Periodontol. 45(Suppl 20):S78-S94. PMID: 29926942
Key Contribution - Current classification standard (2017 EFP/AAP World Workshop). Established:
- Periodontal abscesses (PA) should be classified by etiology: most are in pre-existing periodontal pockets
- PA and EPL (endo-periodontal lesions) are associated with deep pockets, BOP, suppuration, and pain
- PA in periodontitis patients have worse prognosis than in non-periodontitis patients
- Lesions with root fractures or perforations carry the worst prognosis
- Necrotizing periodontal diseases (NPD) are distinct and host-immune-driven
- Framework supports the current EFP/AAP classification system used globally
3. Clinical and Microbiological Characterization
Herrera D, Roldán S, González I, Sanz M. (2000)
"The periodontal abscess (I). Clinical and microbiological findings."
J Clin Periodontol. 27(6):387-94. PMID: 10883867
Key Contribution - Definitive clinical/microbiological characterization in 29 consecutive patients:
- 62% of abscesses affected untreated periodontitis patients
- 69% were associated with molar teeth
- 90% of patients reported pain; bleeding occurred in all abscesses; suppuration in 66%
- Mean associated pocket depth: 7.28 mm; 79% of teeth had mobility
- Cervical lymphadenopathy in 10%; elevated WBC in 31.6%
- High prevalence of: Fusobacterium nucleatum, Peptostreptococcus micros, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus (now T. forsythia)
- Established that PA can cause systemic involvement
4. First Microbiological Characterization (Historical Landmark)
Newman MG, Sims TN. (1979)
"The predominant cultivable microbiota of the periodontal abscess."
J Periodontol. 50(7):350-4. PMID: 38308
Key Contribution - First major microbiological study of the periodontal abscess. Established:
- Gram-negative anaerobic bacteria dominate the abscess flora
- Fusobacterium spp. and Prevotella melaninogenica are prominent
- The polymicrobial anaerobic nature of periodontal abscess microflora
- This paper is a historical cornerstone cited in virtually every textbook on the topic
5. Acute Periodontal Lesions - Updated Review
Herrera D, Alonso B, de Arriba L, Santa Cruz I, Serrano C, Sanz M. (2014)
"Acute periodontal lesions."
Periodontol 2000. 65(1):149-77. PMID: 24738591
Key Contribution - Comprehensive 2014 update bridging the older Herrera 2000 review and the 2018 classification:
- Clarifies differences between PA in pre-existing pockets vs. healthy sites
- Therapy = drainage + tissue debridement as the core approach
- Systemic antimicrobial therapy is case-by-case (local + systemic factors guide decision)
- Definitive treatment of underlying disease must follow after the acute phase
- Covers differential diagnosis with necrotizing diseases, endo-perio lesions, and mucocutaneous conditions
- Metronidazole is the first-line systemic antibiotic option when indicated
6. Systemic Antibiotics in Periodontal Therapy (Evidence Base)
Haffajee AD, Socransky SS, Gunsolley JC. (2003)
"Systemic anti-infective periodontal therapy. A systematic review."
Ann Periodontol. 8(1):115-81. PMID: 14971252
Key Contribution - Systematic review providing evidence base for antibiotic use in periodontal conditions including abscess:
- Documents outcomes with amoxicillin + metronidazole, metronidazole alone, azithromycin, tetracyclines
- Supports adjunctive antibiotic use for severe/rapidly progressive presentations
- Widely referenced when establishing antibiotic protocols for periodontal abscess management
Summary Table for Quick Exam Reference
| Year | Author(s) | Key Contribution |
|---|---|---|
| 1979 | Newman & Sims | First microbiological study; Gram-negative anaerobic flora |
| 2000 | Herrera et al. | Definitive review; 3rd most common dental emergency; etiology classification |
| 2000 | Herrera et al. (Part I) | Clinical/micro characterization; P. gingivalis, F. nucleatum, P. intermedia |
| 2003 | Haffajee et al. | Systematic review; evidence for adjunctive antibiotics |
| 2014 | Herrera et al. | Updated review; drainage + debridement as core; metronidazole 1st line |
| 2018 | Herrera et al. | Current standard - 2017 World Workshop; etiology-based classification; prognosis data |
Exam-Ready Key Points
- Definition: Localized accumulation of pus in periodontal tissues; classified as periodontitis-associated (most common - in pre-existing pocket) or non-periodontitis-associated (foreign body, radicular anomaly)
- Frequency: 3rd most frequent dental emergency (Herrera 2000)
- Microbiology: Gram-negative anaerobic rods dominate - P. gingivalis, P. intermedia, F. nucleatum, T. forsythia, Peptostreptococcus spp. (Newman 1979; Herrera 2000 Part I)
- Clinical features: Pain (90%), BOP (100%), suppuration (66%), deep pockets (~7 mm), tooth mobility; systemic signs possible (lymphadenopathy, leukocytosis)
- Treatment: Drainage + scaling/debridement - mandatory; antibiotics adjunctive only when: systemic involvement, spreading infection, immunocompromised patient (metronidazole or amoxicillin-metronidazole combination)
- Current classification (2018 World Workshop): Etiology-based - (a) in pre-existing periodontal pocket (most frequent), (b) in non-periodontitis patient
- Prognosis: Worse in periodontitis patients; root fracture/perforation = worst prognosis (Herrera 2018)
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