Dental Abscess Clinical Presentation

Updated: Jan 22, 2019
  • Author: Jane M Gould, MD, FAAP; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Presentation

History

The following may be reported in patients with dental abscess:

  • Localized pain and swelling (may progress over a few hours to days): Examples of swelling are shown in the following images.

    Obvious swelling of the right cheek due to dental Obvious swelling of the right cheek due to dental abscess.
    Side view. Fluctuant mass extending toward the buc Side view. Fluctuant mass extending toward the buccal side of the gum end to the gingival-buccal reflection.
  • Thermal sensitivity (periapical abscess)

  • Fever

  • Gingival bleeding (on occasion with periodontal abscess)

  • Decreased intake of fluid, food, or both

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Physical

Gingiva

  • Swelling

  • Warmth

  • Erythema

  • Fluctuant mass that usually extends toward the buccal side of the gum and to the gingival-buccal reflection

  • Parulis or "gum boil" (a soft, solitary, reddish papule located facial and apical to a chronically abscessed tooth that occurs at the endpoint of a draining dental sinus tract) [7]

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, indicating involvement of the masticator space

  • Difficulty swallowing (dysphagia)

  • Respiratory difficulty

  • Necrotizing fasciitis [8]

Neck or facial swelling (see Complications)

Signs of dehydration

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Causes

Dental caries are caused by the following:

  • "Infant-bottle" tooth decay or "nursing" caries: The term "early childhood" caries is replacing these terms because the description also includes dental caries in breastfed babies. The American Academy of Pediatrics (AAP) along with the American Academy of Pediatric Dentistry issued a clinical report entitled "Oral and Dental Aspects of Child Abuse and Neglect," which states that the caregivers of children who present for dental care with severe early childhood caries must be carefully interviewed to differentiate caregivers with adequate knowledge and willful failure to seek dental care from caregivers without knowledge or awareness of a child's dental needs. Failure to seek dental care may result from many socioeconomic factors, and clinicians should determine if dental care is readily available and accessible when considering the possibility of negligence. Physicians and dentists are required by law to report suspected cases of child negligence and abuse. [9]

  • Plaque: This is a noncalcified precipitate of microorganisms and their byproducts that adheres 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 without attachment loss or with nonprogressing attachment loss.

Posttraumatic infection or postsurgical infection may also cause dental abscess.

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