Dental abscess
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
- Clinical evaluation
- Radiographs
Management
- Analgesia with NSAIDs, opiates and local anesthetics
- Dental follow-up within 48 hrs.
- Emergent oral surgeon followup if complicated (Ludwig's angina, 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
- 11 or 12 blade stab incision
- Hemostat blunt dissection +/- packing
See Also
References
- ER Atlas