Dental Abscess

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CLINICAL DESCRIPTION

A fluctuant swelling found in relation to or around a carious tooth caused by spread of infection following the death of the pulp.

CLINICAL FEATURESSIGNS AND SYMPTOMS

  • Tenderness of the tooth when tapped. Painful swelling which is either localized or sometimes spreads to other adjacent tissues. It is found on the apical region of the tooth and could be with or without sinus. There is tenderness, headache and patient may be febrile. The abscess could be pointing or discharging.

INVESTIGATIONS

  • X−ray (intra−oral)

TREATMENTNON-PHARMACOLOGICAL 

  • Consider incision and drainage

PHARMACOLOGICAL 

  • Give Amoxycillin 250 mg - 500 mg 8 hourly for 7 days and give Metronidazole 200 mg - 400 mg (Children:7.5 mg/kg/dose) 8 hourly for 7 days or
  • Give Benzyl Penicillin 1-2 MU (Children: 25,000 units/kg/dose) IM or IV 6 hourly for 7 days and
  • Give Metronidazole 250 mg - 500 mg IV 8 hourly for 7 days
  • Give Aspirin 300mg - 600 mg 8 hourly
  • If abscess persists after 2 weeks, do culture and sensitivity
  • Remove source of infection:
    • Extraction of infected tooth
    • Root canal therapy /Apicectomy

ALTERNATIVELY

  • Give Erythromycin 250 mg - 500 mg 6 hourly for 7 days (if allergic to penicillin) and
  • Give Paracetamol 1 g 8 hourly for adults, Children give Paracetamol 250mg 8 hourly
  • Give Ibuprofen 400 mg 8 hourly for adults (if Paracetamol is ineffective)
    • Children give Ibuprofen 200 mg 8 hourly (if Paracetamol is ineffective) 
  • Oral hygiene measures e.g., warm saline washes, povidone iodine washes

Note: For moderate to severe pain, refer to pain management ladder

ADMIT IF

  • Patient is febrile, dehydrated, and weak
  • Severe trismus present
  • Severe swelling is present:
  • Give injectable antibiotics, preferably Crystalline penicillin 2-4 million units 6 hourly for 5 days combined with iv Metronidazole 500 mg and if abscess persists after 2 weeks, do culture and sensitivity