Dental abscess
Updates to Article Attributes
Dental (periapical) abscesses are 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
Dental 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 of 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:
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deep neck space infections
second and third molar periapical abscesses preferentially spread into the masticator and submandibular spaces (most common, ~80%), as the roots of these teeth extend below the insertion of the mylohyoid muscle which separates the submandibular space from the sublingual space.
periapical abscesses of the other teeth usually spread into the facial soft tissue or sublingual space as their roots extend above the insertion of the mylohyoid muscle 6,7
infection of the maxillary molars can involve the masticator space, maxillary sinuses and palate. Infection involving the masticator space can extend intracranially through the foramen ovale along the course of the trigeminal nerve (V3 branch) 8.
Differential diagnosis
Possible differential considerations include:
-<li>well-defined lucency at or distal to the root apex, usually <10 mm with or without surrounding (<22 mm) sclerosis <sup>2-4</sup>-</li>-<li>the tooth or teeth involved often show signs of <a href="/articles/dental-caries">caries</a>-</li>-<li>an empty socket may indicate recent extraction for infection</li>- +<li><p>well-defined lucency at or distal to the root apex, usually <10 mm with or without surrounding (<22 mm) sclerosis <sup>2-4</sup></p></li>
- +<li><p>the tooth or teeth involved often show signs of <a href="/articles/dental-caries">caries</a></p></li>
- +<li><p>an empty socket may indicate recent extraction for infection</p></li>
-<li><a href="/articles/osteomyelitis">osteomyelitis</a></li>- +<li><p><a href="/articles/osteomyelitis">osteomyelitis</a></p></li>
- +<li><p><a href="/articles/leptomeningitis">meningitis</a> and <a href="/articles/cerebral-abscess-1">cerebral abscess</a></p></li>
- +<li><p><a href="/articles/ludwig-angina">Ludwig angina</a></p></li>
-<a href="/articles/leptomeningitis">meningitis</a> and <a href="/articles/brain-abscess-1">cerebral abscess</a>-</li>-<li><a href="/articles/ludwig-angina">Ludwig angina</a></li>-<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/masticator-space">masticator</a> and <a href="/articles/submandibular-space">submandibular spaces</a> (most common, ~80%), as the roots of these teeth extend below the insertion of the mylohyoid muscle which separates the submandibular space from the sublingual space.</li>-<li>periapical abscesses of the other teeth usually spread into the facial soft tissue or <a href="/articles/sublingual-space-1">sublingual space</a> as their roots extend above the insertion of the <a href="/articles/mylohyoid-muscle">mylohyoid muscle</a> <sup>6,7</sup>-</li>-<li>infection of the maxillary molars can involve the masticator space, maxillary sinuses and palate. Infection involving the masticator space can extend intracranially through the <a href="/articles/foramen-ovale-skull">foramen ovale</a> along the course of the trigeminal nerve (V3 branch) <sup>8</sup>.</li>- +<p><a href="/articles/deep-spaces-of-the-head-and-neck">deep neck space</a> infections</p>
- +<ul>
- +<li><p>second and third molar periapical abscesses preferentially spread into the <a href="/articles/masticator-space">masticator</a> and <a href="/articles/submandibular-space">submandibular spaces</a> (most common, ~80%), as the roots of these teeth extend below the insertion of the mylohyoid muscle which separates the submandibular space from the sublingual space.</p></li>
- +<li><p>periapical abscesses of the other teeth usually spread into the facial soft tissue or <a href="/articles/sublingual-space-1">sublingual space</a> as their roots extend above the insertion of the <a href="/articles/mylohyoid-muscle">mylohyoid muscle</a> <sup>6,7</sup></p></li>
- +<li><p>infection of the maxillary molars can involve the masticator space, maxillary sinuses and palate. Infection involving the masticator space can extend intracranially through the <a href="/articles/foramen-ovale-skull">foramen ovale</a> along the course of the trigeminal nerve (V3 branch) <sup>8</sup>.</p></li>
-<li><a href="/articles/odontogenic-sinusitis">odontogenic sinusitis</a></li>- +<li><p><a href="/articles/odontogenic-sinusitis">odontogenic sinusitis</a> and <a href="/articles/oroantral-fistula-1" title="Oroantral fistula">oroantral fistula</a></p></li>
-<li><a href="/articles/periapical-cyst">periapical cyst</a></li>-<li><a href="/articles/periapical-granuloma">periapical granuloma</a></li>- +<li><p><a href="/articles/periapical-cyst">periapical cyst</a></p></li>
- +<li><p><a href="/articles/periapical-granuloma">periapical granuloma</a></p></li>
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