eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Dental Abscess: Differential Diagnoses & Workup

Author: Jane M Gould, MD, FAAP, Assistant Professor of Pediatrics, Drexel University College of Medicine; Hospital Epidemiologist, Attending Physician, Section of Infectious Diseases, St Christopher's Hospital for Children
Coauthor(s): Jeffrey J Cies, PharmD, BCPS, Pharmacy Clinical Coordinator, Critical Care Clinical Pharmacist, St Christopher's Hospital for Children
Contributor Information and Disclosures

Updated: Feb 5, 2010

Differential Diagnoses

Buccal bifurcation cyst
Incomplete apexification of an erupted tooth
Langerhans cell histiocytosis
Periapical granuloma or cyst
Peritonsillar Abscess

Other Problems to Be Considered

Gingivostomatitis
Parotiditis
Facial cellulitis
Sinusitis
Neoplasms

Workup

Laboratory Studies

  • Uncomplicated (ie, simple) dental abscess: No laboratory studies are required.
  • Complicated abscess (accompanying cellulitis)
    • The CBC count may reveal leukocytosis with neutrophil predominance.
    • Obtain a blood culture (aerobic and anaerobic) before initiating parenteral antibiotics.
    • Needle aspirate is indicated for Gram stain and aerobic and anaerobic cultures.

Imaging Studies

  • Depending on severity of abscess based on clinical presentation the following is recommended:
    • Periapical radiography is the first level of investigation. It provides a localized view of the tooth and its supporting structures. Widening of the periodontal ligament space or a poorly defined radiolucency may be noted.
    • Panoramic radiography (pantomography) is most helpful in emergency situations because it provides the most information for all teeth and supporting structures.
  • If cellulitis swelling extends beyond local area then the following is indicated:
    • Lateral and anteroposterior neck views to rule out a soft tissue neck mass that impinges on the airway.
    • CT scanning with intravenous contrast is the most accurate method to determine the location, size, extent, and relationship of the inflammatory process to the surrounding vital structures.

Procedures

  • Confirm presence of the abscess via needle aspiration.
    • If pus is obtained, do not aspirate more than 1-2 drops. Leave the abscess as large as possible to make the area easier to find for further management.
    • If pus cannot be aspirated, manage medically until a more localized infection develops.
  • Incision and drainage may be performed only if pus can be aspirated.
  • Packing a periapical abscess is generally not necessary.

Histologic Findings

  • The flora at different oral sites varies. The surface of the carious tooth usually contains acid producing aerobic and anaerobic bacteria including Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus. S mutans is the only organism recovered from decaying dental fissures. Obligate anaerobes such as Propionibacterium, Eubacteria, Arachnia, Lactobacillus, Bifidobacterium, and Actinomyces constitute most organisms isolated from carious dentin. The bacteria isolated from inflamed pulp and root canals are aerobic, facultative anaerobic and strict anaerobic organisms, in addition to yeast.
  • Anaerobes usually outnumber aerobes and facultative anaerobes.
  • Most odontogenic infections involve plaque organisms.
  • Supragingival plaque mainly consists of gram-positive facultative anaerobes or microaerophilic cocci and rods.
  • Subgingival plaque consists of anaerobic gram-negative rods with motile form, including spirochetes.

More on Dental Abscess

Overview: Dental Abscess
Differential Diagnoses & Workup: Dental Abscess
Treatment & Medication: Dental Abscess
Follow-up: Dental Abscess
Multimedia: Dental Abscess
References
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References

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Further Reading

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Keywords

dental abscess, odontogenic abscess, tooth abscess, dentoalveolar abscess, periapical abscess, periodontal abscess, pericoronitis, tooth infection, infected tooth, dental caries, pulpitis, infant bottle tooth decay, Ludwig's angina, simple dentoalveolar abscess, odontogenic infection, early-childhood caries, caries, gingivitis, plaque, teeth problem, tooth problem, diagnosis, treatment

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Contributor Information and Disclosures

Author

Jane M Gould, MD, FAAP, Assistant Professor of Pediatrics, Drexel University College of Medicine; Hospital Epidemiologist, Attending Physician, Section of Infectious Diseases, St Christopher's Hospital for Children
Jane M Gould, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, and Society for Healthcare Epidemiology of America
Disclosure: AstraZeneca Salary Employment

Coauthor(s)

Jeffrey J Cies, PharmD, BCPS, Pharmacy Clinical Coordinator, Critical Care Clinical Pharmacist, St Christopher's Hospital for Children
Jeffrey J Cies, PharmD, BCPS is a member of the following medical societies: American College of Clinical Pharmacy and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Medical Editor

Halim Hennes, MD, MS, Pediatric Emergency Medicine Research Director, Professor, Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin
Halim Hennes, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Wayne Wolfram, MD, MPH, Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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