ACUTE PERIAPICAL ABSCESS

Dental Abscess

Infection with pus formation at the root of a tooth as a sequel to pulpitis caused by dental caries or trauma

Causes

  • Mixed bacterial flora but mainly Staphylococcus spp

Clinical features

  • Severe pain that disturbs sleep
  • Facial swelling may be localized in the gum or extend to adjacent tissues
  • Abscesses of the mandibular incisors or molars may discharge extra orally
  • Affected tooth is mobile and tender to percussion
  • Fever and headache may be present if infection has spread

Differential diagnosis

  • Gingivitis
  • Swelling due to trauma
  • Pain due to sinusitis, temporomandibular joint pain dysfunction syndrome, or erupting wisdom teeth
  • Dentine sensitivity due to thermal, tactile, or osmotic stimulus

MANAGEMENT

Infections localized to a tooth and its surroundings (swelling limited to the gum and no signs of
infection extending to anatomical structures, or general signs of infection)

  • Pain relief (paracetamol and/or ibuprofen)
  • Root canal therapy if possible or extraction of tooth
    • NO NEED of antibiotics since they cannot reach the site of infection

If infection is spreading to local adjacent structures (painful gingival and buccal swelling) or systemic signs and symptoms (fever) are present:

  • Surgical treatment
  • Then amoxicillin 500 mg every 8 hours
    Child: amoxicillin dispersible tablets 25 mg/kg (max 250 mg) every 8 hours
  • Plus metronidazole 400 mg every 8 hours
    Child: 10-12.5 mg/kg (max 200 mg per dose)
  • Paracetamol 1 g every 8 hours
    Child: 10-15 mg/kg every 8 hours
  • Or Ibuprofen 400 mg every 8 hours
    Child: 7-13 mg/kg every 8 hours