OVERVIEW

What is a gum abscess?

A gum abscess is an inflammation of the gums caused by food impaction or infection, primarily characterized by bright red and swollen gum papillae, abscess rupture, and pain. Treatment involves removing local irritants, administering antibiotics, and other methods. Regular dental cleanings after treatment and actively addressing food impaction can prevent recurrence. Generally, the condition is mild but affects eating, severely impacting the patient's quality of life.

Are gum abscesses common?

Gum abscesses are relatively common and can occur in people of all ages. Acute multiple gum abscesses often occur in spring and autumn.

What are the classifications of gum abscesses?

Based on the cause, they can be classified into impaction-type and infection-type. Infection-type includes acute multiple gingival abscesses and acute necrotizing ulcerative gingivitis.

Which department should I visit for a gum abscess?

Patients should visit the dentistry department. If the hospital has specialized divisions, the periodontal department is preferred.

SYMPTOMS

What are the common symptoms and manifestations of gingival abscess?

• Patients may observe redness and swelling of the gingival papilla, or even the formation of small abscesses or necrotic ulcers on the gingival papilla;

• The affected area bleeds easily when sucked or even spontaneously;

• Patients experience a sense of swelling pain, tenderness, throbbing pain, which may sometimes radiate to adjacent teeth;

• Self-perceived oral odor and increased saliva production;

• Severe cases may present with systemic symptoms such as low-grade fever, fatigue, and swollen local lymph nodes.

What are the common manifestations of mild gingival abscess?

Mild gingival abscess is usually seen in the impaction type: Patients have a history of dental trauma from picking teeth or dental fillings, or food impaction may be observed in the gingival papilla. The gingival papilla is red, swollen, and uncomfortable, prone to bleeding, with spontaneous swelling pain and obvious tenderness. There may even be pain from hot or cold stimuli and percussion pain in the teeth.

What are the common manifestations of severe gingival abscess?

Severe cases are often seen in infectious gingival abscesses, such as acute multiple gingival abscesses and acute necrotizing ulcerative gingivitis.

• Acute multiple gingival abscesses: Manifested as swelling and throbbing pain in multiple gingival papillae, with small abscesses forming in each gingival area. The pain is severe, and the oral mucosa beyond the gums is red, swollen, and congested.

• Acute necrotizing ulcerative gingivitis: Presents as necrotic ulcers on the gingival papilla or gingival margin, covered with a gray-white pseudomembrane. The gingival margin changes shape, appearing "linear." Submandibular lymph nodes are swollen, accompanied by systemic symptoms such as low-grade fever, fatigue, and elevated white blood cell count.

Where does gingival abscess commonly occur?

As the name suggests, gingival abscess occurs in the gums, specifically in the area closest to the neck of the tooth, known as the gingival papilla or gingival margin.

How does gingival abscess develop?

Gingival abscess has a relatively acute onset, and the course is generally short, usually within two weeks. Acute multiple gingival abscesses have a longer course, slow response to treatment, and symptoms that come and go.

What severe consequences can gingival abscess cause?

It generally does not lead to serious complications. However, if acute necrotizing ulcerative gingivitis is not treated promptly during the acute phase or if the patient has a weakened immune system, it can spread to the lips and cheeks. It may also combine with infection by Clostridium perfringens, leading to necrosis and perforation of the cheek, systemic toxic symptoms, and even death. However, such cases have become extremely rare in China.

CAUSES

What are the causes of gingival abscess?

The causes of gingival abscess can generally be divided into two categories:

• Impaction type: Caused by food impaction irritating the gums, improper tooth picking or dental filling, leading to acute gingival papillitis, which may develop into a suppurative infection and form a gingival abscess in severe cases.

• Infection-related:

• Acute multiple gingival abscess: Patients often have chronic gingivitis before the onset, with a large number of bacteria attached to the junction of teeth and gums, forming plaque. When immunity declines (e.g., due to cold, fatigue, or lack of sleep), local bacteria multiply rapidly, and their virulence increases, triggering the disease.

• Acute necrotizing ulcerative gingivitis: Mainly caused by infection with fusiform bacilli, spirochetes, or Prevotella intermedia. Patients often have chronic gingivitis or periodontitis before the onset. Most patients have a history of smoking. Studies also suggest that stress, fatigue, mental stimulation, malnutrition (especially vitamin C deficiency), and severe wasting diseases are related to this condition.

Which groups are most susceptible to gingival abscess?

People with poor oral hygiene, improper flossing habits for food impaction, smokers, and those with weakened immunity are more prone to gingival abscess.

Is gingival abscess contagious?

Gingival abscess is not contagious.

DIAGNOSIS

How is a gum abscess diagnosed?

When diagnosing a gum abscess, doctors primarily rely on clinical symptoms: the local gum morphology, whether there is an abscess in the gum papilla, and whether there is food impaction or unsuitable dental filling material in the area.

What tests are needed for patients with a gum abscess?

Generally, no special tests are required. If acute necrotizing ulcerative gingivitis is suspected, a bacteriological smear test of the affected area may be performed.

What is a bacteriological smear test for diagnosing a gum abscess?

The bacteriological smear test is mainly used to check for the presence of fusiform bacilli, spirochetes, necrotic tissue, and other mixed bacteria, which can aid in diagnosis. The procedure is simple—a small sample of necrotic tissue from the affected area is taken—and causes minimal discomfort.

Are gum abscess, periodontal abscess, and alveolar abscess the same condition? How are they distinguished?

Due to the broad range of gum areas, a gum abscess may be confused with conditions like alveolar abscess or periodontal abscess. Although all three manifest in the gums within the mouth, they are not the same disease.

• A gum abscess occurs in the gum area closest to the teeth, specifically the gum papilla or gingival margin.

• An alveolar abscess develops in the gum near the tooth root, often in teeth that have previously experienced sensitivity to hot or cold or spontaneous pain.

• A periodontal abscess is located between the gingival margin and the tooth root, occurring within a deep periodontal pocket and usually accompanied by tooth mobility. Doctors need to conduct examinations for confirmation, such as assessing tooth mobility, the presence of deep periodontal pockets, tooth decay, prior treatments on adjacent teeth, or a history of thermal sensitivity or spontaneous pain in nearby teeth. A dental X-ray may be necessary for a definitive diagnosis.

TREATMENT

Can gum abscess heal on its own?

Generally, treatment is needed to intervene in the disease process; otherwise, it may persist or recur easily.

How is gum abscess treated?

Treatment methods for gum abscess vary depending on the cause:

Acute gingival papillitis caused by impaction, etc.:

• Remove local irritants such as food, fish bones, or unsuitable dental fillings;
• If there are local tartar or plaque, professional cleaning can be performed;
• Local irrigation with 1%–3% hydrogen peroxide may be applied.

Bacterial causes:

• Acute multiple gingival abscess: Systemic antibiotics are less effective. First, remove tartar through professional cleaning, eliminate local irritants, then irrigate the affected area with 1%–3% hydrogen peroxide, and apply topical anti-inflammatory medications.

• Acute necrotizing ulcerative gingivitis: Remove tartar and local irritants through professional cleaning, then irrigate and wipe the affected area with 1%–3% hydrogen peroxide, followed by repeated rinsing. Systemic vitamin C and protein support therapy may be given, along with oral anti-inflammatory drugs like metronidazole to control infection.

After controlling these two conditions, it is necessary to address the pre-existing gingival inflammation, usually through professional cleaning.

• Surgical treatment is suitable for large abscesses with obvious fluctuation, where incision and drainage may be performed.

Does gum abscess require hospitalization?

Gum abscess generally does not require hospitalization. However, if the infection is severe and accompanied by systemic symptoms, hospitalization may be needed.

What are the common side effects of gum abscess medications?

For acute necrotizing ulcerative gingivitis caused by infection, oral metronidazole can be used, with common side effects being gastrointestinal discomfort.

Can gum abscess be cured completely?

It can be cured. After recovery, maintaining oral hygiene and regular professional cleaning can prevent recurrence. However, for recurrent or difficult-to-treat acute multiple gingival abscesses, diabetes screening should be considered.

DIET & LIFESTYLE

What should patients with gum abscess pay attention to in daily life?

• Maintain a light diet during the illness, avoid spicy and irritating foods, eat more vegetables and fruits, balance meat and vegetables, and supplement adequate vitamin C and protein.

• Avoid smoking as much as possible;

• If food impaction occurs, resolve it promptly, such as filling cavities between teeth in time;

• For naturally large gaps between teeth, use dental floss or floss picks to clean impacted food regularly;

• Get professional teeth cleaning (scaling) 1-2 times a year to remove tartar and plaque;

• Ensure sufficient sleep, balance work and rest, and learn self-regulation when under stress or emotional tension.

PREVENTION

Can gum abscess be prevented? How to prevent gum abscess?

Gum abscess can be prevented.

• Brush your teeth after meals and use dental floss to thoroughly clean your teeth and gaps between them.

• Infectious types often involve generalized gum inflammation before onset. The key to addressing gum inflammation is removing local irritants. Get professional teeth cleaning 1-2 times a year to remove tartar and plaque.