Periodontal abscess — ORE Part 1 MCQ

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HardPeriodontologyPeriodontal abscessORE Part 1

A 64-year-old patient with known periodontitis has sudden pain and swelling beside an upper molar. Probing reveals a 9 mm pocket with suppuration, the tooth is vital, and the periapical radiograph shows vertical bone loss but no apical radiolucency. He is afebrile. What is the most likely diagnosis?

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Correct answer: D — Periodontal abscess

The correct answer is D: Periodontal abscess. This diagnosis is supported by multiple converging features: (1) pre-existing periodontitis providing the substrate for acute exacerbation; (2) a 9 mm deep periodontal pocket with suppuration, indicating pus accumulation in the gingival wall of the pocket; (3) a vital tooth (the key discriminator), ruling out endodontic origin; (4) periapical radiograph showing vertical bone loss pattern characteristic of periodontitis, with no apical radiolucency (which would indicate pulpal pathology); and (5) systemic health (afebrile). Option E (acute apical abscess) is definitively excluded because the tooth is vital and there is no apical radiolucency. Option A (reversible pulpitis) does not explain the localized suppurating pocket or facial swelling. Option B (dentine hypersensitivity) does not present with acute swelling or suppuration. Option C (alveolar osteitis) occurs only after extraction. UK SDCEP guidance emphasizes that vitality testing is essential to distinguish periodontal abscess from combined endodontic-periodontal lesions or lesions of pulpal origin.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Acute Periodontal Conditions. Management of Acute Dental Problems and Acute Periodontal Conditions. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/acute-periodontal-conditions/ and https://madp.sdcep.org.uk/content/conditions-library/acute_periodontal_conditions.html