Periapical Abscess

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Periapical Abscess is a localized collection of pus at the root of a tooth, usually caused by an infection that has spread from a tooth to the surrounding tissues.

Causes

  • Dental caries or nonviable teeth
  • Significant erosion of the pulp with bacterial overgrowth

Signs and symptoms

  • 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
  • Small white pustule (parulis) in gingival surface characteristic for abscesses may be observed
  • Tender, swollen lymph nodes under the jaw or neck
  • Sudden rush of foul-smelling and foul-tasting, salty fluid in the mouth and pain relief, if abscess ruptures
  • Mobile tooth

Investigations

  • Tenderness on percussion (vertical percussion)
  • X-ray

Treatment Objectives

  • Relieve symptoms
  • Eliminate infections

Non-pharmacological treatment

  • Extraction of the posterior teeth
  • Incision and Drainage

Pharmacological treatment

Paracetamol

1gm oral every 6 hours for 3 days

OR

Ibuprofen 400mg every 8 hours

OR

Diclofenac 50mg every 8 hours

AND

Amoxicillin-clavulanate 875 mg oral every 12 hours for 7 days

OR

Clindamycin 300 mg oral every 8 hours for 7 days 

OR

Ampicillin/Sulbactam 3g IV every 6 hours for 7 day

Prevention

  • Brush teeth at least twice a day with fluoride toothpaste.
  • Daily dental flossing or an interdental cleaner
  • Replace toothbrush every three or four months, or when bristles are frayed.
  • Regular dental check-ups and professional cleanings.
  • Regular use of an antiseptic or a fluoride mouth rinse to add an extra layer of protection against tooth decay.