Dental abscess: Difference between revisions
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*Acute pain, swelling, and mild tooth elevation | *Acute pain, swelling, and mild tooth elevation | ||
*Exquisite sensitivity to percussion or chewing on the involved tooth | *Exquisite sensitivity to percussion or chewing on the involved tooth | ||
*Swelling in surrounding gingiva | *Swelling in surrounding gingiva, buccal, lingual or palatal regions | ||
*May see small white pustule (parulis) in gingival surface characteristic for abscesses | |||
*May see small white pustule in gingival surface characteristic for abscesses | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 16:11, 27 November 2017
Background
- Associated with dental caries or nonviable teeth
- Significant erosion of the pulp with bacterial overgrowth
Clinical Features
- Acute pain, swelling, and mild tooth elevation
- Exquisite sensitivity to percussion or chewing on the involved tooth
- Swelling in surrounding gingiva, buccal, lingual or palatal regions
- May see small white pustule (parulis) in gingival surface characteristic for abscesses
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
Other
Evaluation
- Normally clinical
Management
- Appropriate analgesia
- Dental follow-up within 48 hrs.
- Emergent oral surgeon followup if complicated (Ludwig's, Lemierre's syndrome)
Antibiotics
Treatment is broad and focused on polymicrobial infection
- Amoxicillin-clavulanate 875 mg PO q12 hours x 7-14 days
- Clindamycin 450 mg PO q8 hours x 7-14 days
- Penicillin VK 500 mg PO q6 hours x 7-14 days (frequently prescribed but no longer recommended as monotherapy)
- Ampicillin/Sulbactam 3g IV q6 hours x 7 days
I&D
- Can be performed in ED depending on provider comfort or by a dental consultant
Procedure
- Probe with 18g needle
- Purulent
- 11 blade stab incision
- Hemostat blunt dissection +/- packing
See Also
References
- ER Atlas