Dental Abscess (Odontogenic Abscess)
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Dental abscess is an acute lesion characterized by localization of pus (caused by polymicrobial infection) in the structures that surround the teeth.
Clinical presentation
- Fever and chills
- Throbbing pain of the offending tooth
- Swelling of the gingiva and sounding tissues
- Pus discharge around the gingiva of affected tooth/teeth
- Trismus (inability to open the mouth)
- Regional lymph nodes enlargement and tender
- Aspiration of pus
Investigation
- Pus for Gram stain, culture, and sensitivity if the patient doesn’t respond to initial antibiotic treatment.
Non-pharmacological Treatment
- Incision and drainage and irrigation (irrigation and dressing is repeated daily). Irrigation is done with 3% hydrogen peroxide followed by 0.9% sodium chloride
- Supportive therapy carried out depending on the level of debilitation. Most patients need rehydration and detoxification using 0.9% sodium chloride (IV) or compound sodium lactate (IV)
Pharmacological Treatment
A: amoxicillin (PO) 500mg 8hourly for 5days
AND
A: metronidazole (PO) 400mg 8hourly for 5days.
In severe cases,
B: amoxicillin + clavulanic acid (FDC) (PO) 625mg 8hourly for 5days
AND
A: metronidazole (PO) 400mg 8hourly for 5days.
If a patient is allergic to penicillin
A: erythromycin (PO) 500mg 8hourly for 5days
Where parenteral administration of antibiotics is necessary (especially when the patient cannot swallow and has life threatening infection), consider the following
B: ceftriaxone (IV) 1gm once daily for 5days
AND
B: metronidazole (IV) 500mg 8hourly for 5days
AND
A: gentamicin (IV) 80mg 8hourly for 5days
Note: Incision and drainage is mandatory in cases of deeper spaces involvement followed by a course of antibiotics. The practice of prescribing antibiotics to patients with abscess and denying referral for definitive care until pus has established or resolved has been found to lead to more problems for orofacial infections therefore early referral for definitive care is important.