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.