Dental Abscess

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Dental Abscess is a collection of pus in the pulp of a tooth that can spread to the local (gum, alveolar bone) or regional (oral, cervical, facial) structures.

Causes

  • Trauma
  • Infections caused by untreated cavity
  • Injury from dental appliance.
  • Poor oral hygiene
  • Dental caries

Signs and symptoms

  • Fever
  • Swelling of the gum around the affected tooth resulting in facial swelling
  • Pain
  • Bad breath

Differential diagnosis

  • Periapical granuloma or cyst

Complications

  • Dental cyst
  • Osteomyelitis
  • Ludwig’s angina

Investigations

  • X-ray of affected tooth

Treatment objectives

  • Relieve pain
  • Drain pus
  • Treat infection

Non-pharmacological treatment

  • Supra and Sub gingival Scaling
  • Root planning
  • Frequent mouth rinse with saline or antiseptic mouthwash

Pharmacological treatment

Paracetamol oral 

Adult:

500mg-1g every 6-8 hours

Child:

6-12 years: 250-500mg every 6-8 hours

1-5 years: 120-250mg every 6-8 hours

3 months-1 year: 60-120mg every 6-8 hours when required

OR

Ibuprofen oral

Adult:

200-400mg every 8hours

Child:

100-200mg every 8 hours

AND

Amoxicillin oral

Adult:

500mg every 8 hours for 7 days

Child:

6-12 years:  250mg every 8 hours for 7 days

1-5 years: 125mg every 8 hours for 7 days

 <1 year:   62.5mg every 8 hours for 7days

AND

Metronidazole oral

Adult:

400mg every 8 hours for 7 days

Child:

100-200mg every 8 hours for 7 days

OR

Clindamycin oral

Adult:

150-300mg every 6-8 hours for 7days

Child:

3-6mg/kg every 6 hours for 7 days

Referral

  • Refer immediately to a dental surgeon after initiation of treatment

Prevention

  • Good oral hygiene
  • Use of fluoride-containing toothpaste