Dental Abscess Clinical Presentation
- Author: Jane M Gould, MD, FAAP; Chief Editor: Russell W Steele, MD more...
History
The following may be reported in patients with dental abscess:
- Localized pain and swelling (may progress over a few hours to days): Examples of swelling are shown in the following images.
Obvious swelling of the right cheek. 
Side view. Fluctuant mass extending toward the buccal side of the gum end to the gingival-buccal reflection. 
Gingiva with swelling and erythema. - Thermal sensitivity (periapical abscess): This is thought to occur secondary to exposure of the dentine to the external environment as a result of enamel loss or gingival recession.
- Fever
- Gingival bleeding (on occasion with periodontal abscess)
- Decreased intake of fluid, food, or both
Physical
Gingiva
- Swelling
- Warmth
- Erythema
- Fluctuant mass that usually extends toward the buccal side of the gum and to the gingival-buccal reflection
- Parulis or "gum boil" (a soft, solitary, reddish papule located facial and apical to a chronically abscessed tooth that occurs at the endpoint of a draining dental sinus tract)[6]
Teeth: The tooth that is most frequently involved is the lower third molar, followed by other lower posterior teeth; upper posterior teeth are involved much less frequently, and anterior teeth are rarely involved.
- Increased mobility (mostly periapical abscess)
- Pressure or percussion tenderness (mostly periapical abscess)
- Extrusion
Regional lymph node involvement
More severe infection
- Trismus, indicating involvement of the masticator space
- Difficulty swallowing (dysphagia)
- Respiratory difficulty
- Necrotizing fasciitis[7]
Neck or facial swelling (see Complications)
Signs of dehydration
Causes
Dental caries are caused by the following:
- "Infant-bottle" tooth decay or "nursing" caries: The term "early childhood" caries is replacing these terms because the description also includes dental caries in breastfed babies. The American Academy of Pediatrics (AAP) along with the American Academy of Pediatric Dentistry issued a clinical report entitled "Oral and Dental Aspects of Child Abuse and Neglect," which states that the caregivers of children who present for dental care with severe early childhood caries must be carefully interviewed to differentiate caregivers with adequate knowledge and willful failure to seek dental care from caregivers without knowledge or awareness of a child's dental needs. Failure to seek dental care may result from many socioeconomic factors, and clinicians should determine if dental care is readily available and accessible when considering the possibility of negligence. Physicians and dentists are required by law to report suspected cases of child negligence and abuse.[8]
- Plaque: This is a noncalcified precipitate of microorganisms and their byproducts that adheres to the enamel of teeth.
In immunocompromised patients, bacteria may hematogenously spread to invade the pulp of the tooth.
Gingivitis is an inflammation of the gingiva without attachment loss or with nonprogressing attachment loss.
Posttraumatic infection or postsurgical infection may also cause dental abscess.
[Guideline] Krebs KA, Clem DS 3rd. Guidelines for the management of patients with periodontal diseases. J Periodontol. Sep 2006;77(9):1607-11. [Medline].
Seow WK. Diagnosis and management of unusual dental abscesses in children. Aust Dent J. Sep 2003;48(3):156-68. [Medline].
Stefanopoulos PK, Kolokotronis AE. The clinical significance of anaerobic bacteria in acute orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Oct 2004;98(4):398-408. [Medline].
[Best Evidence] Brook I. Microbiology and management of endodontic infections in children. J Clin Pediatr Dent. 2003;28(1):13-7. [Medline].
[Best Evidence] Robertson D, Smith AJ. The microbiology of the acute dental abscess. J Med Microbiol. Feb 2009;58(Pt 2):155-62. [Medline].
Delaney JE, Keels MA. Pediatric oral pathology. Soft tissue and periodontal conditions. Pediatr Clin North Am. Oct 2000;47(5):1125-47. [Medline].
Jain S, Nagpure PS, Singh R, Garg D. Minor trauma triggering cervicofacial necrotizing fasciitis from odontogenic abscess. J Emerg Trauma Shock. Jul 2008;1(2):114-8. [Medline].
Kellogg N,. Oral and dental aspects of child abuse and neglect. Pediatrics. Dec 2005;116(6):1565-8. [Medline].
Brauer HU. Unusual complications associated with third molar surgery: A systematic review. Quintessence Int. Jul-Aug 2009;40(7):565-72. [Medline].
[Guideline] American Academy of Pediatrics Committee on Nutrition. Fluoride supplementation for children:interim policy recommendations. Pediatrics. 1995;95:777.
Ferrera PC, Busino LJ, Snyder HS. Uncommon complications of odontogenic infections. Am J Emerg Med. May 1996;14(3):317-22. [Medline].
Flynn TR, Shanti RM, Levi MH, et al. Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg. Jul 2006;64(7):1093-103. [Medline].
Gill Y, Scully C. The microbiology and management of acute dentoalveolar abscess: views of British oral and maxillofacial surgeons. Br J Oral Maxillofac Surg. Dec 1988;26(6):452-7. [Medline].
Hall V, Collins MD, Hutson RA, et al. Actinomyces oricola sp. nov., from a human dental abscess. Int J Syst Evol Microbiol. Sep 2003;53(Pt 5):1515-8. [Medline]. [Full Text].
LeJeune HB, Amedee RG. A review of odontogenic infections. J La State Med Soc. Jun 1994;146(6):239-41. [Medline].
Lewis MA, MacFarlane TW, McGowan DA. A microbiological and clinical review of the acute dentoalveolar abscess. Br J Oral Maxillofac Surg. Dec 1990;28(6):359-66. [Medline].
Lewis MA, MacFarlane TW, McGowan DA. Antibiotic susceptibilities of bacteria isolated from acute dentoalveolar abscesses. J Antimicrob Chemother. Jan 1989;23(1):69-77. [Medline].
Pynn BR, Sands T, Pharoah MJ. Odontogenic infections: Part one. Anatomy and radiology. Oral Health. May 1995;85(5):7-10, 13-4, 17-8 passim. [Medline].
Sands T, Pynn BR, Katsikeris N. Odontogenic infections: Part two. Microbiology, antibiotics and management. Oral Health. Jun 1995;85(6):11-4, 17-21, 23 passim. [Medline].
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