Treatment of acute conditions

Refer to Section 5 of the full guidance

General advice for the treatment of acute periodontal conditions

  • Acute conditions should be managed using local measures in the first instance.
  • Do not prescribe antibiotics unless there is evidence of spreading infection or systemic involvement.
  • Recommend optimal analgesia.
  • Following acute management, review within ten days and carry out further supra- and sub-gingival instrumentation as required and arrange an appropriate recall interval.

See below for advice on the specific management of acute periodontal conditions.

Treat as recommended in general advice above and:

  • Carry out endodontic treatment of the affected tooth.
  •  Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.

Patients with periodontitis can, on occasion, present with localised pain and swelling due to nondraining infection of a periodontal pocket.

Treat as recommended in general advice above and:

  • Carry out careful sub-gingival debridement short of the base of the periodontal pocket; local anaesthesia may be required.
  • If pus is present in a periodontal abscess, drain by incision or through the periodontal pocket. 
  • Recommend the use of 0.2% chlorhexidine mouthwash until the acute symptoms subside.

Treat as recommended in general advice above and:

  • Use Oral Hygiene TIPPS to address inadequate plaque removal. Where applicable, give smoking cessation advice.
  • Remove as much supra-gingival plaque, calculus and stain and sub-gingival deposits as can be tolerated by the patient; local anaesthesia may be required.
  • Recommend the use of 6% hydrogen peroxide mouthwash until the acute symptoms subside.
  • If there is evidence of spreading infection or systemic involvement, consider prescribing metronidazole.
  • If no resolution of signs and symptoms occurs, review the patient’s general health and consider referral.