In the described case, which diagnosis best explains swelling and purulence around teeth #2 and #3?

• A. Periodontal abscess
• B. Periapical abscess
• C. Odontogenic cyst
• D. Gingival abscess

Answer: (A)

Swelling with purulence in the gingival area around multiple adjacent teeth points to an infection in the periodontal tissues rather than the tooth pulp. A periodontal abscess forms when an acute infection develops within a periodontal pocket or surrounding gingiva, leading to rapid gingival swelling, surrounding erythema, and purulent drainage from the pocket. The pulp of the involved teeth can remain vital, and the problem is driven by periodontal destruction rather than pulp necrosis.

In contrast, a periapical abscess centers on the apex of a tooth with a necrotic pulp, usually presenting as tenderness to percussion, a nonvital tooth, and a radiolucency at the tooth’s apex. An odontogenic cyst grows slowly and typically presents as a painless swelling with a radiolucent lesion on imaging, not an acute purulent swelling around multiple teeth. A gingival abscess tends to be localized to the gingival tissue around a single tooth or a small area, rather than involving two neighboring teeth.

Therefore, the description fits a periodontal abscess, explaining the swelling and purulence around both teeth.