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Oral Surgery/causes of gum abscesses


QUESTION: Would a gum abscess caused by periodontal disease outwardly look like one caused by a bad tooth? How does one determine if an abscess in the gums is due to a bad tooth or periodontal disease? (Assume the tooth shows no visible sign of cavity or fracture.)

Is it possible that osteomyelitis of the mandible, could CAUSE a gum abscess that mimics a dental abscess?

ANSWER: Bob - First of all, periodontal disease is the most common cause of gum abscesses.  The difference between the gum abscess vs the tooth one is usually the position of the abscess.  If it shows with swelling at the gum tooth line, then it is usually periodontal.  If, however, the swelling of the abscess is lower down and the tooth is often sensitive if you tap on it then it is most likely due to a tooth abscess.

Osteomyelitis on the mandible is a significant problem and not as common in men.  It usually develops from an infection in a tooth that has been there for a long time and no treatment has been done.  On xray, it is significantly different and a knowledgeable dentist should be able to recognize it.  Early on it does not always produce pain, but the continued growth of the osteo will eventually cause pain in the bone and the surrounding area.  It can cause a more generalized swelling that does not usually look like a simple gum infection.

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QUESTION: Thank you for your quick reply. I'd like to give you a few details about my situation and then ask a followup.

I had a severe abscess from tooth #19, and it was pulled. (They said it had a fracture, and a root canal couldn't save it.)

Months later, I still have lingering symptoms at the extraction site: slight swelling and drainage at the outer gum. The swelling has been there all along (although it waxes and wanes), but the drainage didn't start until about a month after the extraction. I don't have any pain.

I have been on five different antibiotics, which always alleviate the symptoms, but never eradicate the problem.

The dentists and oral surgeons can't find a fistula, and there's so little drainage that there's no visible exudate. But I can feel the sticky stuff and taste it with my tongue. It completely coats the swollen area.

With no identified fistula, I imagine the drainage process analogous to sweat. That is, maybe it comes out of tiny pores, but they're so small that it seems to ooze out everywhere.

I know that osteomyelitis sometimes drains to the gums, and I fear that's what I have. Does osteomyelitis drain through a fistula, or can it just ooze out all over an area of the gums, like sweat on the skin?

I just noticed something strange a couple of days ago. I was chewing some gum and discovered that the swollen area, which is usually rather soft and mushy, had hardened dramatically! When I stopped chewing, it softened back up fairly quickly.

It's almost as if the act of chewing pumped it up, like a tire low on air. (Yes, I do like analogies.) I tried chewing on the right side only, and the swollen area on the left still hardened. So contact with the chewing gum does not produce this effect. It must be the act of vigorous, continuous chewing.

Does the chewing gum effect (or anything else mentioned above) suggest osteomyelitis? Or any other diagnosis?

Thank you for your attention.

Bob -  Of course, without examining you I cannot be completely sure, but osteomyelitis produces discomfort, swelling and a very bad taste.  I cannot be sure without examining you or viewing an xray of the area, but you need to area evaluated to ward off a problem if it is osteomyelitis or treated if some other situation exists.

So do yourself a favor and make an appointment with a board certified oral and maxillofacial surgeon to evaluate the region and intercept a potential problem now.

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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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