Dental abscess

Dental abscess covers a clinical spectrum from minor well-localized infection to severe life-threatening complications involving multiple fascial spaces.

The vast majority of otherwise healthy patients presenting with a dental infection can be managed on an outpatient basis.

Common presenting symptoms include dental pain/toothache; intraoral and/or extraoral edema, erythema, or discharge; and thermal hypersensitivity.

A major consideration is the potential for airway obstruction as a consequence of extension of the infection into fascial spaces surrounding the oropharynx.

Panoramic dental x-ray reveals the source of infection in most cases; however, a periapical x-ray may also be helpful. A computed tomography scan is recommended if there is suspicion of a fascial space infection or if panoramic or periapical x-rays are not available.

Prompt operative intervention to identify and eliminate the source of infection and provide a path for drainage, along with antibiotic therapy and supportive care, is required. Operative treatment is considered the cornerstone of successful management.

Immunocompromised patients must be treated in a timely fashion as tooth-related infections may spread rapidly.

A dental abscess is the final product of an inflammatory process, a suppurative collection associated with the structures surrounding the teeth. It is a type of odontogenic infection (i.e., an infection that originates within a tooth).

An abscess may remain localized (damaging only the adjacent tissues) or it may develop into a diffuse cellulitis, which can lead to the development of potentially life-threatening systemic complications.

The vast majority of otherwise healthy patients have localized infections which can be managed on an outpatient basis.

The most common types of dental abscess are periapical, periodontal, and pericoronal. Other less common types include gingival or combined periodontal-endodontic. This topic primarily deals with the most common types of dental abscess.