Acute Dento-alveolar Abscess (Dental abscess)

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Description

A dento-alveolar abscess is an acute lesion characterized by localization of pus in the structures that surround the teeth.

 

Usually the origin is a bacterial infection that has accumulated in the soft, often dead, pulp of the tooth. This can be caused by tooth decay, broken teeth or extensive periodontal disease (or combinations of these factors) or a failed root canal treatment.

Signs and Symptoms

  • The pain is continuous and may be described as extreme, growing, sharp, shooting, or throbbing
  • Sensitive to touch
  • Swelling on the affected side
  • Redness
  • Partial trismus
  • Pus discharge

Investigations

Pus for Grams stain, culture and sensitivity if the patient doesn’t respond to initial antibiotic treatment.

Treatment

Supportive

  • Incision and drainage and irrigation (irrigation and dressing is repeated daily)
  • Irrigation is done with 3% hydrogen peroxide followed by 0.9% Normal
  • 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

  • Amoxicillin 500mg (PO) 8 hourly for 5 days OR
  • Azithromycin 500mg (PO) once a day for 3 - 5days OR
  • Erythromycin 500mg (PO) 6 hourly for 5- 7 days AND
  • Metronidazole 400 mg (PO) 8 hourly for 5
  • Severe cases
    • Amoxicillin Clavulanic acid 625mg (PO) 8 hourly for 5 days AND
    • Metronidazole 400 mg (PO) 8 hourly for 5
  • If patients are allergic to penicillins:
    • 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 days AND
    • Metronidazole 500 mg IV 8 hourly for 5 days

 Criteria for Referral to Dental/Maxillofacial Surgeon

  • Rapidly progressive infection
  • Difficulty in breathing
  • Difficulty swallowing
  • Fascia space involvement
  • Elevated body temperature (greater than 390C)
  • Severe jaw trismus/failure to open the mouth (less than 1cm)
  • Toxic appearance
  • Compromised host defences