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