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Dental Abscess Treatment & Management

  • Author: Jane M Gould, MD, FAAP; Chief Editor: Russell W Steele, MD  more...
 
Updated: Apr 21, 2015
 

Medical Care

In patients with dental abscess, assess the airway upon respiratory distress, oropharyngeal tissue swelling, or inability to handle secretions; then, secure the airway via endotracheal intubation or tracheostomy.

  • Properly collect specimen for Gram stain and aerobic and anaerobic cultures.
  • Administer empiric antibiotic therapy if necessary.
  • Administer analgesia.
  • Hydrate the patient.
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Surgical Care

The primary therapeutic modality is surgical drainage of any pus collection. A pulpectomy or incision and drainage is the recommended management of a localized acute apical abscess in the permanent dentition. Incision and drainage or spontaneous rupture of the abscess quickly accelerates resolution of the infection. The addition of antibiotics is not recommended for a localized dental abscess.

Emergent surgery is indicated in the operating room if the airway is threatened or if the patient's condition is rapidly deteriorating.

Third molar removal is a common surgical procedure.[9]

A retrospective analysis of all patients affected by an odontogenic infection that received surgical therapy from 2004 to 2011 under stationary conditions reported that two patients per week affected by an odontogenic infection required stationary surgical treatment and about two patients per year were likely to require additional intensive medical care. The study also reported that if well-known risk factors are present in patients affected by odontogenic infection, appropriate interdisciplinary management should be considered as early as possible.[10]

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Consultations

Consult a dentist if the patient has an uncomplicated abscess.

Consult a maxillofacial oral surgeon if the patient has a complicated abscess.

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Diet

Diet is as tolerated. However, a soft bland diet is usually preferred.

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Activity

Activity is as tolerated.

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Contributor Information and Disclosures
Author

Jane M Gould, MD, FAAP Associate 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, Society for Healthcare Epidemiology of America

Disclosure: Partner received salary from Teva Pharmaceuticals for employment.

Coauthor(s)

Jeffrey J Cies, MPH, PharmD, BCPS Pharmacy Clinical Coordinator, Critical Care Clinical Pharmacist, Infectious Diseases Clinical Pharmacist, St Christopher’s Hospital for Children

Jeffrey J Cies, MPH, PharmD, BCPS is a member of the following medical societies: American College of Clinical Pharmacy, American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Halim Hennes, MD, MS Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center

Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Karen Schneider, MD, to the original writing and development of this article.

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

  2. Seow WK. Diagnosis and management of unusual dental abscesses in children. Aust Dent J. 2003 Sep. 48(3):156-68. [Medline].

  3. Stefanopoulos PK, Kolokotronis AE. The clinical significance of anaerobic bacteria in acute orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Oct. 98(4):398-408. [Medline].

  4. Brook I. Microbiology and management of endodontic infections in children. J Clin Pediatr Dent. 2003. 28(1):13-7. [Medline].

  5. Robertson D, Smith AJ. The microbiology of the acute dental abscess. J Med Microbiol. 2009 Feb. 58(Pt 2):155-62. [Medline].

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  8. Kellogg N,. Oral and dental aspects of child abuse and neglect. Pediatrics. 2005 Dec. 116(6):1565-8. [Medline].

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

  10. Opitz D, Camerer C, Camerer DM, Raguse JD, Menneking H, Hoffmeister B, et al. Incidence and management of severe odontogenic infections-a retrospective analysis from 2004 to 2011. J Craniomaxillofac Surg. 2015 Mar. 43(2):285-9. [Medline].

  11. [Guideline] American Academy of Pediatrics Committee on Nutrition. Fluoride supplementation for children:interim policy recommendations. Pediatrics. 1995. 95:777.

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

  13. Flynn TR, Shanti RM, Levi MH, et al. Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg. 2006 Jul. 64(7):1093-103. [Medline].

  14. Gill Y, Scully C. The microbiology and management of acute dentoalveolar abscess: views of British oral and maxillofacial surgeons. Br J Oral Maxillofac Surg. 1988 Dec. 26(6):452-7. [Medline].

  15. Hall V, Collins MD, Hutson RA, et al. Actinomyces oricola sp. nov., from a human dental abscess. Int J Syst Evol Microbiol. 2003 Sep. 53(Pt 5):1515-8. [Medline]. [Full Text].

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

  17. Lewis MA, MacFarlane TW, McGowan DA. A microbiological and clinical review of the acute dentoalveolar abscess. Br J Oral Maxillofac Surg. 1990 Dec. 28(6):359-66. [Medline].

  18. Lewis MA, MacFarlane TW, McGowan DA. Antibiotic susceptibilities of bacteria isolated from acute dentoalveolar abscesses. J Antimicrob Chemother. 1989 Jan. 23(1):69-77. [Medline].

  19. Pynn BR, Sands T, Pharoah MJ. Odontogenic infections: Part one. Anatomy and radiology. Oral Health. 1995 May. 85(5):7-10, 13-4, 17-8 passim. [Medline].

  20. Sands T, Pynn BR, Katsikeris N. Odontogenic infections: Part two. Microbiology, antibiotics and management. Oral Health. 1995 Jun. 85(6):11-4, 17-21, 23 passim. [Medline].

 
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Obvious swelling of the right cheek due to dental abscess.
Side view. Fluctuant mass extending toward the buccal side of the gum end to the gingival-buccal reflection.
 
 
 
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