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An acute abscess may be painless but still have a swelling present on the gum. It is important to get anything that presents like this checked by a dental professional as it may become chronic later. In some cases, a tooth abscess may perforate bone and start draining into the surrounding tissues creating local facial swelling.
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The tooth may be mobile, and the lesion may contribute to destruction of the periodontal ligament and alveolar bone. [4] The pain is deep and throbbing. The oral mucosa covering an early periodontal abscess appears erythematous (red), swollen and painful to touch. [3] The surface may be shiny due to stretching of the mucosa over the abscess.
Tooth #5, the upper right second premolar, after extraction. The two single-headed arrows point to the CEJ, which is the line separating the crown (in this case, heavily decayed) and the roots. The double headed arrow (bottom right) shows the extent of the abscess that surrounds the apex of the palatal root.
It is important to note that an apical abscess may drain through the periodontal pocket giving a false interpretation of periodontal abscess or a periodontal abscess may appear at the apex of the tooth giving a false interpretation of apical abscess; a tooth may also have both lesions at one point in time. [4]
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.