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Periapical abscess
Periapical abscess

Periapical abscess

Introduction

This clinical condition arises as a complication of inflammation of the dental pulp or periodontal pocket. The condition may be acute and diffuse, chronic with fistula or localized and circumscribed. It is located in the apical aspect of the supporting bone

Pathophysiology

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Signs and symptoms

• Severe, persistent, throbbing toothache
• Sensitivity to hot and cold temperatures
• Tooth pain that radiate to the jawbone, neck or ear
• Sensitivity to the pressure of chewing or biting
• Fever
• Swelling of face or cheek
• Tender, swollen lymph nodes under jaw or in neck
• Sudden rush of foul-smelling and foul-tasting and salty fluid in mouth
• Pain relief if the abscess ruptures
• Difficulty breathing or swallowing for a large abscess

Diagnostic criteria

• The patient complains of tooth ache
• Pain during intake of hot or cold foods/drinks
• Pain on bringing the tooth on occlusion
• Tenderness on percussion (vertical percussion)
• Swelling of gingiva around the affected tooth

Investigation

• Periapical X-ray of the aching tooth- for abscess identification
• CT scan of the tooth to determine if the infection have spread to other areas within the neck

Treatment

Non-pharmacological

    • For posterior teeth

    Extraction of the offending tooth under local anesthesia (can perform root canal treatment for posterior teeth instead of tooth extraction under good clinical judgement)

    • Lignocaine 2% with adrenaline 1:80,000 IU (to establish drainage) is the treatment of choice followed by analgesics.

    • For anterior teeth (incisors, canine and premolars: extraction is carried out only when root canal treatment is not possible

Pharmacological

    • Paracetamol 1gm (PO) 6 hourly for 3 days.

    Antibiotics may be given if the condition is chronic and depending on radiological findings such as bone radioluscence to depict bone resorption and periapical granuloma.

    • Amoxicillin 500mg (PO), 8 hourly for at least 7 days
    OR
    • Erythromycin 500mg (PO) 8 hourly for 7 days (if allergic to penicillin)
    AND
    • Metronidazole 400mg (PO) 8 hourly for 7 days

Prevention

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Updated on,

4 Novemba 2020, 10:46:15

References

1.STG
2. Mayo clinic. Tooth abscess. https://www.mayoclinic.org/diseases-conditions/tooth-abscess/diagnosis-treatment/drc-20350907

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