eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Dental Abscess
Updated: Oct 12, 2007
Introduction
Background
A dentoalveolar abscess is an acute lesion characterized by localization of pus in the structures that surround the teeth. Most patients are treated easily with analgesia, antibiotics, drainage, and/or referral to a dentist or oral-maxillofacial surgeon. However, the physician should be aware of potential complications of simple dentoalveolar abscess.
Pathophysiology
The term dentoalveolar abscess comprises 3 distinct processes, as follows:
- A periapical abscess that originates in the dental pulp and is usually secondary to dental caries is the most common dental abscess in children. Dental caries erode the protective layers of the tooth (ie, enamel, dentin) and allow bacteria to invade the pulp, producing a pulpitis. Pulpitis can progress to necrosis, with bacterial invasion of the alveolar bone, causing an abscess.
- A periodontal abscess involves the supporting structures of the teeth (periodontal ligaments, alveolar bone). This is the most common dental abscess in adults but may occur in children with impaction of a foreign body in the gingiva.
- Pericoronitis describes the infection of the gum that overlies a partially erupted third molar.
Odontogenic infections are polymicrobial, with an average of 4-6 different causative bacteria. The dominant isolates are strictly anaerobic gram-negative rods and gram-positive cocci, in addition to facultative and microaerophilic streptococci. Anaerobic bacteria outnumber aerobes 2-3:1.1 In general, strictly anaerobic gram-negative rods are more pathogenic than facultative or strictly anaerobic gram-positive cocci.
Generally, a nonpathologic resident bacterium gains entry when the host's defenses are breached, rather than when a nontypical microorganism is introduced. The predominant species include those of Bacteroides, Fusobacterium, Peptococcus, and Peptostreptococcus, as well as Streptococcus viridans.
Mortality/Morbidity
Mortality is rare and is usually due to airway compromise. Morbidity relates to pain, probable tooth loss, and dehydration. See Complications.
Race
No race predilection is observed.
Sex
No sex predilection is noted.
Age
- Dental abscess is rare in infants because abscesses do not form until teeth erupt.
- In children, periapical abscess is the most common type of dental abscess. This is because of the combination of poor hygiene, thinner enamel, and the primary dentition having more abundant blood supply, which allows for an increased inflammatory response.
- In adults, periodontal abscess is more common than periapical abscess.
Clinical
History
- Localized pain and swelling (may progress over a few hours to days)
- Thermal sensitivity (periapical abscess)
- Fever
- Gingival bleeding (on occasion with periodontal abscess)
Physical
- Gingiva
- Swelling
- Warmth
- Erythema
- Fluctuant mass that usually extends toward the buccal side of the gum and to the gingival-buccal reflection
- 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
- Difficulty swallowing (dysphagia)
- Respiratory difficulty
- Neck or facial swelling (see Complications)
Causes
- Pulpitides are dental caries caused by the following:
- Baby-bottle tooth decay (BBTD): Early-childhood caries is replacing this term because the description also includes dental caries in breastfed babies.
- Plaque: This is a precipitate of denatured salivary proteins that allow bacteria to adhere 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.
- Posttraumatic infection or postsurgical infection may also cause dental abscess.
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
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].
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
