Dental abscess: Difference between revisions
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==Background== | ==Background== | ||
===Periapical vs Periodontal Abscess=== | ===Periapical vs Periodontal Abscess=== | ||
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| Epidemiology||More common||Less common | | Epidemiology||More common||Less common | ||
|- | |- | ||
| Area||Associated with a | | Area||Associated with a nonviable dead tooth (e.g. [[pulpitis]])||Associated with a vital (living) tooth | ||
|- | |- | ||
| Cause||Tooth infection||Gum infection | | Cause||Tooth infection||Gum infection | ||
|} | |} | ||
{{Dental numbers}} | |||
[[File:Periodontium.png|thumb|Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.]] | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 23:10, 2 December 2021
Background
Periapical vs Periodontal Abscess
| Category | Periapical | Periodontal |
| Other Names | Tooth abscess, dentoalveolar abscess, apical abscess, endodontic abscess, and lesion of endodontic origin | Gingival, pericoronal, lateral (periodontal) abscess |
| Epidemiology | More common | Less common |
| Area | Associated with a nonviable dead tooth (e.g. pulpitis) | Associated with a vital (living) tooth |
| Cause | Tooth infection | Gum infection |
Dental Numbering
- Adult (permanent) teeth identified by numbers
- From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
- Children (non-permanent) teeth identified by letters
- Common landmarks:
- 1: Right upper wisdom
- 8 & 9: Upper incisors
- 16: Left upper wisdom
- 17: Left lower wisdom
- 24 & 25: Lower incisors
- 32: Right lower wisdom
Anatomy of the periodontium. The crown of the tooth is covered by enamel (A). Dentin (B). The root of the tooth is covered by cementum. C, alveolar bone. D, subepithelial connective tissue. E, oral epithelium. F, free gingival margin. G, gingival sulcus. H, principal gingival fibers. I, alveolar crest fibers of the periodontal ligament (PDL). J, horizontal fibers of the PDL. K, oblique fibers of the PDL.
Clinical Features
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- 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, opioids and/or local anesthetics
- Dental follow-up within 48 hrs.
- Emergent oral surgeon follow-up 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