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.
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Properly collect specimen for Gram stain and aerobic and anaerobic cultures.
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Administer empiric antibiotic therapy if necessary.
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Administer analgesia.
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Hydrate the patient.
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. [10]
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. [11]
Consultations
Consult a dentist if the patient has an uncomplicated abscess.
Consult a maxillofacial oral surgeon if the patient has a complicated abscess.
Diet
Diet is as tolerated. However, a soft bland diet is usually preferred.
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Obvious swelling of the right cheek due to dental abscess.
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Side view. Fluctuant mass extending toward the buccal side of the gum end to the gingival-buccal reflection.
