Dental Abscess
Introduction
Dental abscess is an acute lesion characterized by localization of pus (caused by polymicrobial infection) in the structures that surround the teeth.
Pathophysiology
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Signs and symptoms
• Fever and chills
• Throbbing pain of the offending tooth
• Swelling of the gingiva and sounding tissues
• Pus discharge around the gingiva of affected tooth/teeth
• Trismus (inability to open the mouth)
• Regional lymph nodes enlargement and tender
• Aspiration of pus for frank abscess
Diagnostic criteria
• Fever and chills
• Throbbing pain of the offending tooth
• Swelling of the gingiva and sounding tissues
• Pus discharge around the gingiva of affected tooth/teeth
• Trismus (inability to open the mouth)
• Regional lymph nodes enlargement and tender
• Aspiration of pus for frank abscess
Investigation
• Pus for Grams stain
• Culture and sensitivity if the patient doesn’t respond to initial antibiotic treatment
Treatment
Non-pharmacological
- • Incision and drainage and irrigation (irrigation and dressing is repeated daily)
• Irrigation is done with 3% hydrogen peroxide followed by 0.9% Normal saline.
• Supportive therapy carried out depending on the level of debilitation (most patients need rehydration and detoxification using IV Normal saline 0.9% or IV Ringers Lactate)
Pharmacological
- Non severe case
• Amoxicillin 500mg (PO) 8 hourly for 5 days
AND
• Metronidazole 400 mg (PO) 8 hourly for 5 days.
Severe cases
• Amoxicillin Clavulanic acid 625mg (PO) 8 hourly for 5 days
AND
• Metronidazole 400 mg (PO) 8 hourly for 5 days.
If patients are allergic to penicillin's:
• Erythromycin 500 mg (PO) 8 hourly for 5 days
Where parenteral administration of antibiotics is necessary (especially when the patient cannot swallow and has life threatening infection), consider
• Ampicillin 500mg IM/IV 6 hourly for 5 days
OR
• Ceftriaxone 1 gm IV once daily for 5 days37
AND
• Metronidazole 500 mg IV 8 hourly for 5 days
Note: Incision and drainage is mandatory in cases of deeper spaces involvement followed by a course of antibiotics. The practice of prescribing antibiotics to patients with abscess and denying referral for definitive care until pus has established or resolved has been found to lead to more problems for orofacial infections THEREFORE early referral for definitive care is important.
Criteria for Referral to Dental/Maxillofacial Surgeon
• Rapidly progressive infection
• Difficulty in breathing
• Difficulty swallowing
• Fascia space involvement
• Elevated body temperature (greater than 390 C)
• Severe jaw trismus/failure to open the mouth (less than 10mm)
• Toxic appearance
• Compromised host defenses
Prevention
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Updated on,
4 Novemba 2020 07:21:55
References
1.STG