Dental Abscess Workup

  • Author: Jane M Gould, MD, FAAP; Chief Editor: Russell W Steele, MD   more...
 
Updated: Feb 5, 2010
 

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.
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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.
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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.

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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.
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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.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

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.

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

References

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  14. 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].

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  17. 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].

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  19. 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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Obvious swelling of the right cheek.
Side view. Fluctuant mass extending toward the buccal side of the gum end to the gingival-buccal reflection.
Gingiva with swelling and erythema.
 
 
 
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