Dental Abscess

Localised collection of pus is known as abscess. Dental abscess can be due to

• Periapical pathology – due to decay and pulp necrosis pus collects at tip of the root of a tooth.
• Periodontal /gingival pathology- due to gum tissue or surrounding structure involvement without affecting tooth.
• Pericoronitis – due to inflammation in soft tissue surrounding the tooth.

Common Signs and Symptoms

Throbbing pain and swelling, warmth around the area and if it perforates sinus drainage is present.

Line of Management

Treatment would involve incision and drainage of abscess, antibiotics and anti-inflammatories and sometimes extraction of teeth. Timely treatment is important to prevent the pus from spreading into surrounding vital structures and serious complications.

What is Abscess?

It is a localized collection of pus in a pathological tissue space. In simple words, it is thick walled cavity containing pus. If it occurred suddenly in less duration it is called acute abscess. It is a bacterial infection mainly due to the multiple organisms .

How patient with abscess appear ?

In general the patient will have fever and will be in a dehydrated state. In local region pain, swelling associated with pus discharge and inability to open the mouth is seen. Pus discharge can be intraoral or with extraoral. Extraoral swelling shows diffuse, redness, stretched and shiny skin. Swelling will be warm, tender with pus discharge on palpation. If the infection spreads to the adjacent soft tissue spaces around the teeth; obliteration of the vestibule, trismus, increased salivation, raised floor of the mouth, wooden type of tongue is seen. In severe cases, it can lead to respiratory difficulty even death.

What to expect at Dentist consultation?

Dentist will evaluate and find the cause of the abscess. Decayed tooth will be found first, through the clinical examination and radiographic examination. Decay tooth also has pain on tapping and redness noticed around the tooth. Dentist will perform treatment for draining the pus and antibiotics to fight infection.

When does a patient with abscess requires admission in hospital??

• Temperature > 101˚F (38.3˚C)d
• Dehydration
• Threat to the airway or vital structures
• Infection in moderate or high severity
• Need for inpatient control of systemic disease

Who is prone for abscess formation?

Diabetic patient, Patients on Steroid therapy, chemotherapy, Chronic renal disease Organ transplants, Malnutrition, Alcoholism. in these condition patients have compromised immune status so they are more susceptible for abscess formation.

How to treat abscess once it forms ?

Treatment is Incision and drainage either intraorally or extra orally followed by appropriate antibiotic therapy along with removal of etiological reason. Fluid intake should be raised and monitored. Incase it is found to be less, intravenous route to administer should be used.

How you can prevent ?

Proper oral hygiene maintenance is mandatory like brushing twice daily with mouthwash. Regular dental check up every once in 3 month followed by restoration of decayed tooth in early stage.

Things to avoid for patient with abscess?

Hot fomentation should not be done as it can cause sudden increase in size of swelling. Don’t keep local medications like campher or cinnamon in the cavited tooth. Stay away from quack.