eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Dental Abscess: Follow-up
Updated: Jul 28, 2009
Follow-up
Further Inpatient Care
- Criteria for hospital admission in patients with dental abscesses include the following:
- Unable to handle secretions
- Airway compromise
- Involvement of facial spaces of head and neck
- Systemic involvement
- Failure of outpatient therapy
Further Outpatient Care
- Follow-up care should be obtained as recommended by a physician.
Deterrence/Prevention
- The most effective preventive measure against dental caries and, thus, dentoalveolar abscess is fluoridation of communal drinking water.
- In fluoride-deficient areas, prevention can be obtained with dietary fluoride supplements. The American Academy of Pediatrics and the American Dental Association recommend administration of fluoride if the concentration of fluoride in the drinking water is less than 0.3 parts per million (ppm). Administer fluoride according to the following age-appropriate schedule (all doses are per day):
- Age birth to 6 months - 0 mg
- Age 6 months to 3 years - 0.25 mg
- Age 3-6 years - 0.5 mg
- Age 6-16 years - 1 mg
- The other effective preventive measure against dental caries and dentoalveolar abscess is proper dental hygiene. This includes brushing teeth after meals and regular dental check-ups.
Complications
- Dentocutaneous fistulae arise from chronic dental infections. The fistulous pathway develops as the chronic inflammation erodes through the alveolar bone, perforates the periosteum, and spreads into the surrounding soft tissues. The diagnosis is often missed because a chronic asymptomatic dental infection is usually present and the skin lesion is mistakenly thought to arise locally.
- Osteomyelitis was common before the era of antibiotic therapy. Osteomyelitis is an inflammation of the medullary cavity and adjacent cortex of bone. The mandible is more commonly involved than the maxilla because the maxilla has a better blood supply.
- Cavernous sinus thrombosis (CST) may be a complication. Approximately 10% of patients with CST have an odontogenic focus. Spread of infection from dental abscesses to the cavernous sinus is believed to occur via the valveless pterygoid venous plexus by way of the retromandibular vein. Patients often present with headache, unilateral retro-orbital pain, periorbital edema, fever, proptosis, chemosis, and ptosis. Treatment consists of antibiotics, anticoagulants, and, occasionally, surgery.
- Ludwig angina is an infection of the submandibular region. Abscesses of the second and third mandibular molars may perforate the mandible and spread into the submandibular and submental spaces. Ludwig angina is manifest by swelling of the floor of the mouth and elevation and posterior displacement of the tongue. A rapidly spreading gangrenous cellulitis produces a brawny edema of the suprahyoid region of the neck. The infection begins unilaterally but quickly spreads to include the entire neck. The most common presenting symptoms are oral, neck, and dental pain; neck swelling; odynophagia; dysphagia; dysphonia; trismus; and tongue swelling. Airway patency is the main concern. Ludwig angina is unusual in children.
- Maxillary sinusitis may occur from direct extension of an odontogenic infection or from perforation of the floor of the sinus during extraction.
- Facial-space swelling most often involves the following areas:
- Submandibular swelling is caused by dental abscesses from the second or third molars. A firm, ill-defined, and often significant-sized swelling is present below the mandible. The inferior border and angle of the mandible are difficult to palpate.
- Sublingual swelling is caused by any lower tooth whose apex is above the mylohyoid muscle attachment (ie, incisors, canines, premolars, mesial roots of the first molar). Infections produce a unilateral elevation of the floor of the mouth near the offending tooth but can spread across the midline, causing pain, dysphagia, and an elevation of the base of the tongue, leading to potential airway compromise.
- Buccal swelling originates from infected maxillary or mandibular molars. Clinically, infection produces a large tender swelling of the cheek without trismus. Boundaries for this type of infection may extend from the philtrum of the lip, to the border of the parotid, and up to the eye.
- Less frequently involved facial-space swellings include submental, masticator, canine, lateral pharyngeal, and retropharyngeal.
Prognosis
- The prognosis is excellent with proper incision, drainage, antibiotic therapy, tooth extraction, root canal therapy and follow-up care.
Patient Education
- Most dentoalveolar abscesses are preventable.
- Inquire if drinking water is fluorinated. If not, counsel parents about fluoride supplementation (see Deterrence/Prevention).
- Instruct patients about proper dental hygiene, including brushing teeth after meals, flossing, and regular dental check-ups.
- For excellent patient education resources, visit eMedicine's Teeth and Mouth Center and Infections Center. Also, see eMedicine's patient education articles Dental Abscess, Toothache, When to Visit the Dentist, and Antibiotics.
Miscellaneous
Medicolegal Pitfalls
- Failure to consult a dentist if the patient has an uncomplicated abscess
- Failure to consult a maxillofacial oral surgeon if the patient has a complicated abscess
The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Gershon Segal, MD, to the original writing and development of this article.
More on Dental Abscess |
| Overview: Dental Abscess |
| Differential Diagnoses & Workup: Dental Abscess |
| Treatment & Medication: Dental Abscess |
 Follow-up: Dental Abscess |
| Multimedia: Dental Abscess |
| References |
| « Previous Page | Next Page » |
References
[Guideline] Krebs KA, Clem DS 3rd. Guidelines for the management of patients with periodontal diseases. J Periodontol. Sep 2006;77(9):1607-11. [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].
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].
Brauer HU. Unusual complications associated with third molar surgery: A systematic review. Quintessence Int. Jul-Aug 2009;40(7):565-72. [Medline].
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].
Further Reading
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
