Periapical abscess
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This clinical condition arises as a complication of inflammation of the dental pulp or periodontal pocket. The condition may be acute and diffuse, chronic with fistula or localized and circumscribed. It is in the apical aspect of the supporting bone.
Clinical presentation
- The patient complains of tooth ache
- Pain during intake of hot or cold foods/drinks
- Pain on bringing the tooth on occlusion
- Tenderness on percussion (vertical percussion)
- Swelling of gingiva around the affected tooth
Non-pharmacological Treatment
- For posterior teeth: Extraction of the offending tooth under local anesthesia (can perform root canal treatment for posterior teeth instead of tooth extraction under good clinical judgement)
- Perform incisional and drainage under local anesthesia followed by analgesics.
- For anterior teeth (incisors, canine and premolars): extraction is carried out only when root canal treatment is not possible
Pharmacological Treatment
A: paracetamol (PO) 1gm 6hourly for 3days
AND
A: amoxicillin (PO) 500mg 8hourly for at least 7days
OR
A: erythromycin (PO) 500mg 8hourly for 7days (if allergic to penicillin)
AND
A: metronidazole (PO) 400mg 8hourly for 7days