Dental abscess
Updates to Article Attributes
Dental (periapical) abscess is an acute infection of the periapical tissue around the root of the tooth.
Clinical presentation
Patients may present with pain, oedema and purulent discharged localised to the site of pathology with or without fever and tender cervical lymphadenopathy 1.
Pathology
Caries result in damage to the tooth enamel, which allows bacteria access to the dental pulp. From here the infection spreads down the root canal and out the apical foramen where abscess formation occurs 2,4.
Radiographic features
Early dental abscesses, within the first ten days, may not have any radiographic features 3-4.
Plain radiograph/OPG and CT
- well-defined lucency at or distal to the root apex, usually less than 1 cm with or without surrounding (<22 mm) sclerosis 2-4
- the tooth or teeth involved often show signs of caries
- an empty socket may indicate recent extraction for infection
Treatment and prognosis
Some dental abscesses will spontaneously resolve but dental surgery and antibiotics are generally required 1,4.
Complications
Dental abscesses can exert pressure on the root of the tooth, which contains the neurovascular bundle, and can lead to devitalisation of the tooth 5.
Complications range from contiguous or haematogenous spread of infection and include potentially fatal conditions 1-4:
- osteomyelitis
- meningitis and cerebral abscess
- Ludwig's angina
- deep neck space infections
- odontogenic infections most commonly (~80%) affect the submandibular space 5
- sinusitis
Differential diagnosis
-<li>deep neck space infections<ul><li>odontogenic infections most commonly (~80%) affect the <a title="submandibular space" href="/articles/submandibular-space">submandibular space</a> <sup>5</sup>- +<li>deep neck space infections<ul><li>odontogenic infections most commonly (~80%) affect the <a href="/articles/submandibular-space">submandibular space</a> <sup>5</sup>
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