Treatment
Acute Management — Drainage
Emergency — drainage is definitive treatment
- • I&D if fluctuant: scalpel incision at most dependent point of swelling
- • Curettage through pocket orifice + irrigation with 0.2% chlorhexidine or 3% H₂O₂
- • Ultrasonic debridement of the pocket
- • DO NOT extract acutely — increased bacteraemia risk, poor LA efficacy in infected tissue
Antibiotics — Adjunctive Only
Only with systemic signs — NEVER as sole treatment
- • Fever >38°C, lymphadenopathy, cellulitis, trismus → prescribe
- • First choice: Amoxicillin 500mg TDS × 5–7 days
- • Penicillin allergy or anaerobic cover: Metronidazole 400mg TDS
- • Spreading infection: Amoxicillin + Metronidazole combination
Definitive Periodontal Treatment (2–4 weeks later)
After acute phase resolves
- • Full periodontal assessment and staging
- • Full-mouth SRP
- • Periodontal surgery if residual deep pockets
- • Long-term SPT; diabetes and smoking risk factor management