Dental abscess
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Dental (periapical) abscessabscesses isare an acute infection of the periapical tissue around the root of the tooth.
Clinical presentation
Patients may present with pain, oedema, and purulent discharge 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 <10 mm 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. Most (~90%) will show some evidence of healing (bone filling the lucency) one-year post-treatment 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 angina
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deep neck space infections
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odontogenic infections most commonly (~80%) affectsecond and third molar periapical abscesses preferentially spread into the submandibular space (most common, ~80%) whereas periapical abscesses of the other teeth spread into the sublingual space56,7
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- odontogenic sinusitis
Differential diagnosis
Possible differential considerations include:
-<p><strong>Dental (periapical) abscess</strong> is an acute infection of the periapical tissue around the root of the <a href="/articles/tooth">tooth</a>.</p><h4>Clinical presentation</h4><p>Patients may present with pain, oedema, and purulent discharge localised to the site of pathology with or without fever and tender cervical lymphadenopathy <sup>1</sup>.</p><h4>Pathology</h4><p>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 <sup>2,4</sup>.</p><h4>Radiographic features</h4><p>Early dental abscesses, within the first ten days, may not have any radiographic features <sup>3,4</sup>.</p><h5>Plain radiograph / OPG and CT</h5><ul>- +<p><strong>Dental (periapical) abscesses</strong> are an acute infection of the periapical tissue around the root of the <a href="/articles/tooth">tooth</a>.</p><h4>Clinical presentation</h4><p>Patients may present with pain, oedema, and purulent discharge localised to the site of pathology with or without fever and tender <a href="/articles/adult-cervical-lymphadenopathy-differential">cervical lymphadenopathy</a> <sup>1</sup>.</p><h4>Pathology</h4><p>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 <sup>2,4</sup>.</p><h4>Radiographic features</h4><p>Early dental abscesses, within the first ten days, may not have any radiographic features <sup>3,4</sup>.</p><h5>Plain radiograph / OPG and CT</h5><ul>
-</ul><h4>Treatment and prognosis</h4><p>Some dental abscesses will spontaneously resolve but dental surgery and antibiotics are generally required <sup>1,4</sup>. </p><h5>Complications</h5><p>Dental abscesses can exert pressure on the root of the tooth, which contains the neurovascular bundle, and can lead to devitalisation of the tooth <sup>5</sup>. </p><p>Complications range from contiguous or haematogenous spread of infection and include potentially fatal conditions <sup>1-4</sup>:</p><ul>- +</ul><h4>Treatment and prognosis</h4><p>Some dental abscesses will spontaneously resolve but dental surgery and antibiotics are generally required <sup>1,4</sup>. Most (~90%) will show some evidence of healing (bone filling the lucency) one-year post-treatment <sup>4</sup>.</p><h5>Complications</h5><p>Dental abscesses can exert pressure on the root of the tooth, which contains the neurovascular bundle, and can lead to devitalisation of the tooth <sup>5</sup>. </p><p>Complications range from contiguous or haematogenous spread of infection and include potentially fatal conditions <sup>1-4</sup>:</p><ul>
-<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>- +<li>
- +<a href="/articles/deep-spaces-of-the-head-and-neck">deep neck space</a> infections<ul><li>second and third molar periapical abscesses preferentially spread into the <a href="/articles/submandibular-space">submandibular space</a> (most common, ~80%) whereas periapical abscesses of the other teeth spread into the <a href="/articles/sublingual-space-1">sublingual space</a> <sup>6,7</sup>
-<li><a href="/articles/acute-sinusitis">sinusitis</a></li>- +<li><a href="/articles/odontogenic-sinusitis">odontogenic sinusitis</a></li>
References changed:
- 6. Chapman MN, Nadgir RN, Akman AS et-al. Periapical lucency around the tooth: radiologic evaluation and differential diagnosis. Radiographics. 2013;33 (1): E15-32. <a href="http://dx.doi.org/10.1148/rg.331125172">doi:10.1148/rg.331125172</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23322846">Pubmed citation</a><span class="auto"></span>
- 7. Rafael M. Loureiro, Erica A. Naves, Rafael F. Zanello, Daniel V. Sumi, Regina L. E. Gomes, Mauro M. Daniel. Dental Emergencies: A Practical Guide. (2019) RadioGraphics. 39 (6): 1782-1795. <a href="https://doi.org/10.1148/rg.2019190019">doi:10.1148/rg.2019190019</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31589571">Pubmed</a> <span class="ref_v4"></span>
- 5. Chapman MN, Nadgir RN, Akman AS et-al. Periapical lucency around the tooth: radiologic evaluation and differential diagnosis. Radiographics. 2013;33 (1): E15-32. <a href="http://dx.doi.org/10.1148/rg.331125172">doi:10.1148/rg.331125172</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23322846">Pubmed citation</a><span class="auto"></span>
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