Periapical abscess

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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
    • None in buccal or submandibular soft tissues
  • May see small white pustule in gingival surface characteristic for abscesses

Differential Diagnosis

Dentoalveolar Injuries

Odontogenic Infections

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 infections

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