eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Dental Abscess: Differential Diagnoses & Workup

Author: Karen Schneider, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine
Contributor Information and Disclosures

Updated: Jul 28, 2009

Differential Diagnoses

Peritonsillar Abscess

Other Problems to Be Considered

Gingivostomatitis
Parotiditis
Facial cellulitises
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 culture.

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.
    • 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 may reveal 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.
  • 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

  1. [Guideline] Krebs KA, Clem DS 3rd. Guidelines for the management of patients with periodontal diseases. J Periodontol. Sep 2006;77(9):1607-11. [Medline].

  2. 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].

  3. 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].

  4. Brauer HU. Unusual complications associated with third molar surgery: A systematic review. Quintessence Int. Jul-Aug 2009;40(7):565-72. [Medline].

  5. Ferrera PC, Busino LJ, Snyder HS. Uncommon complications of odontogenic infections. Am J Emerg Med. May 1996;14(3):317-22. [Medline].

  6. 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].

  7. 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].

  8. 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].

  9. LeJeune HB, Amedee RG. A review of odontogenic infections. J La State Med Soc. Jun 1994;146(6):239-41. [Medline].

  10. 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].

  11. 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].

  12. 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].

  13. 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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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, baby-bottle tooth decay, BBTD, Ludwig angina, Ludwig's angina, simple dentoalveolar abscess, odontogenic infection, pulpitides, early-childhood caries, caries, gingivitis, plaque, teeth problem, tooth problem, diagnosis, treatment

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Contributor Information and Disclosures

Author

Karen Schneider, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine
Karen Schneider, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and American Medical Association
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: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
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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