Dental abscess

Background

• Associated with dental caries or nonviable teeth
• Significant erosion of the pulp with bacterial overgrowth

Clinical

• Acute pain, swelling, and mild tooth elevation
• Exquisite sensitivity to percussion or chewing on the involved tooth
• Swelling in surrounding gingiva
  • None in buccal or submandibular soft tissues
• May see small white pustule in gingival surface characteristic for abscesses

Management

• Antibiotics (penicillin)
• Appropriate analgesia
• Dental follow-up within 48 hrs.

Differential Diagnosis

Dentoalveolar Injuries

• Dental fracture
• Dental subluxation
• Dental avulsion
• Bleeding dental socket

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

• Scurvy
• Gingival hyperplasia
  • Phenytoin
  • Cyclosporine
  • Nifedipine, Amlodipine
  • Leukemia

Treatment

1. I&D (usually done by dentist)
2. Penicillin VK 500mg PO QID OR Clindamycin 300mg PO QID
3. Dental referral

See Also

• Dental Problems

Source

• ER Atlas
• Tintinalli
• UpToDate