Any dentists around? Periodontal abscess

[SallyWD]

I wonder if any dentists can advise me (or anyone who's had a similar problem). I have a deep periodontal pocket (10mm) at the front near the canine tooth. It's always infected. I know this because if I press the gum lots of pus comes out. However most of the time it doesn't bother me at all. I'm not aware of it. There's a slight lump in the gum but it usually doesn't hurt.
Every now and then - maybe twice a year it really flares up and becomes very infected. I get a huge lump, throbbing pain, can't eat or sleep well etc. The treatment is to deep clean and scale it, sometimes I take antibiotics. Then it calms down again for another few months until the next time.. . I've googled treatment and I feel my dentist is doing all he can. I go every 3 months to deep clean the area. He gives me lots of advice about keeping the area clean which I follow religiously (using interdental brushes, floss, corsodyl mouthwash, saline mouthwash).
I always eat on the other side of my mouth. As soon as I've eaten anything I go to the bathroom and clean all around the gum so no food gets stuck there. I even do this at work! I've googled it many times and it seems both my dentist and I are doing all we can. It's been flaring up non-stop for the last month making my life miserable. I hate having this permanent infection and I know it can lead to heart disease, inflammation and cancers (I've already had cancer and wonder if it's related to this).
Just wondered if anyone one else can think of anything which might help. Is there any way to seal up the pocket or some type of gel I could put on the gum to stop it being infected? Thanks!

www.amazon.co.uk/TePe-Interspace-Brush-soft-Heads/dp/B007QP5MUA/ref=asc_df_B007QP5MUA/?tag=googshopuk-21&linkCode=df0&hvadid=310843213580&hvpos=&hvnetw=g&hvrand=1267038825440127149&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=1006530&hvtargid=pla-563364536520&psc=1

Hygienist here.
You need one of these. Tepe Soft Interspace Brush. Jiggle the brush into the pocket daily. You can also use Gengigel on the brush as this may help.
Keep up with the 3 month visits.

I'm sorry you're having so much pain and the currently treatment regime isn't controllong things.
At 10mm it would be appropriate to ask for referral to a private periodontal specialist for managment usually surgical or if you have a Dental hospital in your region you may be accepted for specialist treatment.

Try a water flosser, and use it daily.

Yep defo water flosser, and use after every time you eat. Have you researched periochips? They sound good for deep pockets. I imagine only available privately. Cutting out sugar/ alcohol/ smoking important and some supplements eg Q10 meant to be good for gums as well as Bromelaid (pineapple enzyme).

Bromelain even!

I have similar but in my case it's under a root canal treatment. It's starting to destroy the bone and the one of the teeth next to it so my only viable option now is to have it removed and have an implant.

Thank you so much to everyone for your advice. You can't imagine how much it helps. I feel like I have hope now, new things to try! I've already ordered the little brush, the gum gel and the water flosser. The periopegs look really promising too. I think they cost hundreds but will definitely use them if necessary. Also good to know that surgery is an option.
I feel so much better. Thanks again.

You poor thing! Mine is also eating away at the bone. It's a horrible thought, isn't it? My infection is definitely the gum, not the tooth. At the moment the tooth isn't too loose but I know it's only a matter of time. Hope you get the treatment you need.

Hi @SallyWD I hope you don’t mind me posting or sort of messaging you. I know this thread is a few months old but I’m in that position that you were, right now and I’m terribly worried about what might happen so I wondered if you might be able to help or just ease my mind by telling me what happened with your dental problem.
I currently have an abscess and I think it’s my first. I’ve been Googleing so much this weekend that I’ve been in tears. I’m pretty sure that I have periodontal abscess and not a tooth one, only because I have periodontal or gum disease and my gums at the bottom especially are quite receded. I do everything I possibly can to look after my mouth. The problem is that I should have had braces years ago to straighten my teeth but I am 41 and my teeth are very crowded. Touch wood I haven’t yet lost any teeth but I see the hygienist every 3 months for a deep clean and I have a long lengthy routine every day for cleaning my teeth. I go round with my electric tooth brush then the interdental brushes with the coloured handles, then floss and then my new Waterpik water flosser and I do this morning and night but floss and use the interdentals after everything I eat.
Anyway, to cut a long story short I started with pain last week on Tuesday evening and I could see a swelling of gum in the pocket between my one of my two front teeth and the one next to it. So it’s right at the front but luckily covered by my lip. I knew by Weds morning that it was an abscess. It’s sort of between my two teeth but as far as I know I don’t have any problems with either of those teeth. Hopefully not anyway. I’m assuming the abscess is from having infected gums and a deep pocket. I rang the dentist Weds morning but they were all on holiday and I got sent to another practice who saw me and gave antibiotics. It was a five day course and I finished these last night. I thought that seemed a bit short but anyway the pain has gone but the actual abscess/the gummy lump has not gone down at all. It developed a small white head on top yesterday which burst so it I rinsed my mouth with salt water a few times and rang 111 to check that was ok as I was scared I might need to be seen. 111 said it would be ok to find my own dentist tomorrow morning as it’s bank holiday they’re not open until
tomorrow but the lady said I was doing everything I should be and that it may just need draining if there is more pus inside or more Antibiotics to clear it. So my plan is to call the dentist tomorrow morning as soon as they open to get an emergency appointment with my own dentist but I am terrified about what they will do. I’ve read so much about extracting the tooth and root canal, but isn’t this only if you have something wrong with the tooth. If it’s a periodontal abscess then isn’t it caused by the gums being infected and a problem with the gums, and if so, do they leave the tooth alone? I wondered how long it took for your actual abscess to go down and disappear? I’ve had one lot of antibiotics and although it has sorted out the pain, it has not sorted out the lump. I thought it might start to reduce in size but I can also feel a Kelly lump behind the teeth. What can the dentist do or in your case, do you mind telling me what happened with you? And how is it now?
many thanks in advance and again I apologise for this being a few months after the thread.

Use water jet with Perioplus Regenerate (Curoprox).
At 10mm it is pretty much untreatable. Specialist periodontist is probably your best course of action but do your research. Any dentist can set up as a periodontist but very few have specialist status.
NHS referral may be limited and expect over 12 mnths wait.
To check if a periodontist has specialist status look on the GDC registration area.
Most likely you will see the periodontist but be treated by the hygienist, however it’s how you look after it day to day that matters.
I always use the analogy of having a cleaner at home, if they only clean once every 3 mnths and you do no cleaning yourself your how will be pretty dirty.

Thank you @Angrymum22 ,
im not actually sure what size pocket it is where I have ended up with abscess. All the pockets I have are different sizes. I’m more posting to try and find out what they are likely to do about this abscess that hasn’t gone away or down in size. Am I looking at the dentist maybe draining the abscess or more antibiotics or something worse. I don’t know what a periodontist could do. I’m seeing the hygienist ever 3 months for deep cleans and to be honest, things have worsened since been seeing the hygienist.

Hi @LucyintheSky21LucyintheSky21
I'm sorry you're going through this and are so worried. I don't know if my experience will be reassuring to you or make you feel more stressed...
Basically I've had this periodontal abscess for many years. Not sure how many but it could be up to 20 years! I do everything you do with the interdental brushes, water flosser, three monthly deep cleans. However, the lump never goes away. It can change in size on a daily basis really. If ever I press it pus comes out. Sometimes it's huge, sometimes it's a lot smaller but it's always there. As long as it's not hurting then I'm fine with it. Maybe twice a year it'll become very painful and I need to have it drained or have antibiotics. Most of the time it's under control, sometimes there's just a very mild discomfort. A lot of the time it's completely fine.
The dentist has not really offered any solution - he emphasises the need for regular deep cleans and me keeping the area clean on a daily basis (which I do). I've heard of surgical solutions such as stitching up the deep pocket but this has never been suggested and I haven't pursued it.
Things that help me (as well the water flossing etc) are "oil pulling" - Google this. It's an ancient Indian practice of swishing coconut oil around your mouth for 20 minutes. It draws out the bad bacteria that lives in your gums. It definitely makes a difference and I feel it reduces the size of the lump and makes my mouth feel cleaner and more comfortable. I do it a few times a week. Corsodyl mouthwash helps as does Gengigel.
I've been told I'll eventually lose the tooth (or two) but they've been saying this for about 10 years and each time I see them they say "it won't be for a few years" so I've stopped obsessing about it too much. I've looked in to the various options for replacing lost teeth to put my mind at rest.
Basically what I'm saying is don't panic. It's not a nice condition but it can be managed for many, many years. It flares up now and then but can be controlled. All the best.

Hi @SallyWD Thank you so much for your reply. I have been really worried about all of this, mainly because it’s my teeth and of course I don’t want to lose any. Or should I say, I want to hang into them for as long as possible. I’m only early 40’s and I feel very unlucky to be in this position. I’ve had this abscess since last Weds, I’ve been back to my dentist today and they’ve cleaned it and cleaned the two teeth that it’s between and prescribed two antibiotics to take together for a further 7 days. I’ve to go back in two weeks to see if the limo starts to go down. They also did an X-ray and said it appears to be the infected Hun that has caused the abscess and not a tooth issue. I’m assuming that’s a good thing, otherwise they might have wanted to take the tooth out. No one wants that 🫤. I’m grateful for your reply, sometimes it just feels like no matter how hard you try with all your cleaning at home and water flossing etc and deep cleans, that it’s still an ongoing problem.
I’ll have a look at oil pulling, I’ve never heard of that. I do buy Gengivel but I’m not sure how good that is since I’ve ended up with an abscess. So it could be that this abscess never goes away?
many thanks for your advice.

Hi @LucyintheSky21 I just wanted to update as I went to the dentist this morning. He acknowledged that despite all the deep cleaning etc my gum issues aren't improving. He finally referred me to the peridontal specialist at the hospital. I wish that had happened years ago because I now have significant bone loss in my jaw. He said "Let's see if they can do anything." I know about options like stitching up the pockets. I'm interested to see what they suggest.
I fully accept I'm going to lose a couple of teeth eventually and my concern was that I wouldn't be able to get an implant because of the bone loss (nothing to attach the teeth to if the bone's been eaten away!). My gum abscess is right at the front so I really don't want to be toothless. He reassured me by saying many people get bone grafts and then they can have implants. I know this will be very expensive but it's given me hope! I'm going to start saving up now.
What I'm saying is that the worst case scenario is you'll lose a tooth or two but even then they can replace it so try not to worry.

Hi @SallyWD Thank you for updating me on what’s happened today. To be honest, you’ve terrified me. I am terrified by the whole thing and it gets me really down, the state of my gums. The dentist I saw a few weeks ago with my abscess which was throbbing and painful, he said that it is because of how crowded my teeth are that I can’t ever possibly get in there between them all go clean them enough despite how hard I try. He also said it is a real shame that I wasn’t offered braces when I was younger. I am sure it would be too late now and I’m sure my teeth would probably fall out having braces fitted.
I have no idea about bone loss. Would you know yourself if you had bone loss or is it something that only shows on an X-ray? I’m a baby when it comes to work being done and procedures, I am terrified. But I’m more terrified of losing my teeth. None feel loose but my gums are very receded. I bought a water flosser which is wonderful and I have a good dental routine. When I read your original post, that’s like me. I only eat 3 times a day, no snacks between, and as soon as I’ve eaten I use interdentals and floss and water floss. I’ve even started rinsing a lot with salt water instead of mouth wash. It’s very deflating.
I see the hygienist on 2nd October so will find out then if there’s any improvement but i’m dreading it in case there’s no improvement. My abscess has gone down a little bit is still there so I’ve been told it could flare up again and I have to keep making sure I keep the area as clean as I can. I know implants are a fortune. Do you know if dentures partial or full can be made and worn with bone loss?

Oh no, I'm sorry!! I certainly didn't intend to terrify you. I was trying to reassure you!
About the bone loss - the infection in the gum eats at the bone. No I would never have known about it but they spotted it on the x-ray. The tooth where the abscess is, is very slightly loose (and I mean very slightly!) so I assume this is because of the bone loss. I wouldn't have noticed it was loose but of course I tried to wobble it a bit and I saw it was a tiny bit looser than the others. The bone loss must be small if my tooth is only a tiny bit wobbly after all these years of having an abscess. Try not to worry about that. It's an extremely slow process and it can definitely heal - sadly not for me.
The dentist said we can probably keep my 2 teeth for a few more years and I'm just really relieved that I know it can be replaced.
Yes, you can definitely have partial dentures there. That's what I intend to do before the implant. Dentists always say implants are the better option and dentures can be uncomfortable. To be honest, I wouldn't mind a bit of discomfort as long as I don't have a gap in my teeth! My mum has loads of partial dentures in her mouth and she's absolutely fine with it. Doesn't bother her at all.

Hi @SallyWD , it’s fine, honestly I know you’re only intending to help me and be reassuring. I am grateful for your advice. I’m just terrified by the whole thing, I dread going for the dentist. I spend so much of my life in front of the bathroom sink cleaning and flossing and water flossing. It’s soul destroying at times. Is your mum happy with her partial dentures? It would be my worst nightmare to lose any teeth. I reckon I must also have some bone loss but I haven’t been told and I don’t dare ask. I’m hoping my abscess just keeps going down and eventually goes. My dentist is now private so it costs a fortune as well.
Like you, I just want to hold on to my teeth for as long as possible. This might sound daft, but if you have partial or full dentures and they pull teeth in order for this to happen, are you left with gaps etc while you wait for the dentures or are you given something to use until you get the permanent ones? I think I’ll cry when I lose a tooth. Do you also use Gengigel and do you think it’s good for gums?
I’d love to hear from you when you’ve seen the periodontist. Would you mind letting me know when you’ve been, what happens etc?

Yes my mum's happy with the partial dentures. She eats anything she wants. They look really natural to me.
I've already lost a couple of teeth at the back. It's not noticeable and makes no difference to me at all. I never bothered to have them replaced. This is different though because it's at the front it would be very noticeable.
If your abscess is new you probably don't have any bone loss. I really think mine started about 20 years ago but I didn't realise what was going on until it was too late.
Yes I asked the dentist about having partial dentures on the day I lose the teeth. They said it's fine and that's what they'll do. Phew!
I do use Gengigel and think it helps.
Today my dentist gave me a syringe and said I can inject Corsodyl deep in to the pocket. It will kill the bad bacteria. I'm going to do that every day.
Yes, I'll definitely update you. I imagine I'm on a long waiting list and won't see anyone for months but I'll remember to get in touch when I do.

Thank you so much @SallyWD , please do remember me when you see the specialist and I hope it goes really well and that you’re happier when you’ve been. You sound braver than me. You can even private message me.
If dentures are the answer and can be done straight away and with receded gums then that’s reassuring. I think implants are too expensive. I do buy the Gengigel mouthwash but i’m never sure if it helps or doesn’t help.

@mynameiscalypso what did you do in the end

I had the tooth removed. It was very straightforward and healed easily. I’m probably not going to bother with an implant as you can’t see it and I’ve got used to the gap.

@SallyWD how did the deep clean go

Fine thanks. I've had it a few times and it does help but it's a temporary fix. Over time it gets infected again. I just have to be very vigilant at keeping it clean.

@SallyWD is it just near one tooth

Two teeth. It's near the bottom canine and the one next to it.