Updated: Nov 9
Both periodontal abscesses and periapical abscesses are infections that occur in your mouth but the similarities end there. A periodontal abscess originates from the periodontium while a periapical abscess originates from the apices of the tooth root.
Although the terms may look and sound similar, they are in fact completely different dental conditions with different etiologies.
Different enough that if you get the diagnosis wrong, the prescribed treatment will have zero effect on the condition. That means the treatment for a periodontal abscess is NOT the same as the treatment for a periapical one.
Pimple on the gums
Painful or Non-painful
Yes & No
Deep cleaning & Gingival Curettage
The chart above is a concise summary comparing the differences between these two conditions. We will go into greater detail in the next section.
Differences Between Them
The differences between them are due to the fact that a periodontal abscess is a periodontic condition while a periapical abscess is an endodontic condition. Consequently, the former requires periodontic treatment while the latter requires endodontic treatment.
Source of infection
What makes them different conditions is where the source of their infection originates.
A periodontal abscess originates from the periodontium which are the structures surrounding the tooth. This includes the gums, PDL fibers, cementum, and alveolar bone. That is why the suffix for this term has "periodontal" in it.
A periapical abscess originates from within the tooth, usually from the tooth nerve but it develops around the root tip. As its name implies, the infection is "peri" (around) "apical" (root apex).
Type of treatment
Since a periodontal abscess is a periodontal condition, it will require periodontic treatment.
Periodontal abscess treatment:
Scaling and root planing. Commonly known as a deep cleaning, this procedure cleans below the gum line and onto the root surface. It will remove all plaque and tartar from as deep down the tooth root as it can go.
Gingival curettage. In lieu of scraping the root of the tooth, the gums itself will need to be cleaned. This process is know as curetting the gums.
Incision and drainage. If the gum swelling does not subside with the above two, a cut will need to be made into the gums. Then the swelling can be drained.
Antibiotics. You may receive a combination of antibiotic pills with a mouthwash to use at home. Make sure you finish the entire course and follow the directions closely.
Since a periapical abscess is an endodontic condition, it will require endodontic treatment.
Periapical abscess treatment:
Root canal. The source of the infection comes from within the tooth, namely the unhealthy nerve. A root canal procedure will remove the infected nerve from the tooth, thus resolving the source of the abscess.
Incision and drainage. If there is swelling present, a root canal may be insufficient in clearing it out. It may need to be drained by making an incision first.
Antibiotics. Depending on the severity of the swelling you may or may not need to take antibiotics. Usually localized swelling does not need it but diffuse swelling will need it.
How to tell which one you have
The signs and symptoms between these two conditions are very nuanced. We would even go as far as to say that you won't be able to tell which dental abscess you have.
The only way that you'll be able to know which one you have is by seeing a dentist. They will complete a couple of diagnostic tests in order to determine what it is.
Clinical exam - Both of them will look like swelling on the gums but a periodontal abscess is located closer to the gum margin. The periapical one will be further down the gum.
X-rays - Only a periapical abscess will show up with a large radiolucency around the tip of the root. The periodontal one may not show up since the condition is usually acute so it hasn't had enough time to destroy your jaw bone.
Vitality test - The tooth is usually dead for a periapical abscess while a periodontal one may still be alive. Their vitality can be determined by conducting a cold test.
Putting together all of this information, your dentist can give you a proper diagnosis. As you can see, you can't perform even half of these diagnostic tests at home. What that means is don't even bother trying to figure out which condition you have, just go see a dentist.
Despite the similar sounding names, it is important to know if you have a periapical abscess or a periodontal one because they're different conditions. Their treatments are also completely different.
If you get the diagnosis wrong and receive the wrong treatment, what you'll find is that the infection will not go away. So yeah, which one you have does matter!