Dentoalveolar abscess

Periapical Abscess, Dental Abscess, Abscessed Tooth

What is Dentoalveolar abscess?

A dentoalveolar abscess is a pus-filled sac in the tissue around the root of a tooth. An abscess may occur when bacteria invade the nerves and blood vessels, filling the central cavity of the tooth (pulp), and causing the pulp to die. This commonly happens when cavities (dental caries) destroy the tooth's protective enamel and dentin, allowing bacteria to reach the pulp. When a tooth is injured, bacteria can also gain access to the pulp, entering directly through a fracture or along damaged blood vessels. Pus formed by this infection occasionally finds its way to the gumline of the tooth. More often, however, it is discharged into surrounding tissues, causing painful inflammation.

How is it diagnosed?

History: Symptoms include toothache or painful throbbing, swelling or reddening of the gums, extremely painful biting or chewing, and sensitivity to heat and cold. The individual may also complain of fever, headache, and general fatigue.

An untreated abscess eventually erodes a small channel (sinus) through the jawbone to the surface of the gum. Here it forms a gumboil (swelling) that may burst, discharging foul-tasting pus into the mouth.

Physical exam: In addition to the symptoms found around the affected tooth, the abscess may spread through surrounding tissues and bone, producing swollen glands in the neck and the side of the face.

Tests: An x-ray will confirm diagnosis.

How is Dentoalveolar abscess treated?

Treatment is aimed at saving the tooth. A root canal procedure drains the abscess by drilling down through the crown of the tooth and into the pulp cavity, allowing the pus to escape. After cleaning and disinfecting the pulp cavity, the cavity is filled with antibiotic paste and covered with a temporary filling. An antibiotic may be prescribed if the infection has spread beyond the tooth. After a week or so, the filling is removed and the canal examined to be certain the infection has been eliminated. The canal is then filled with dental cement, and the tooth fitted with an artificial crown.

If the tooth cannot be saved, it is extracted and the abscess drained. Antibiotics are prescribed to clear any residual infection.

Medications

Information Brand Generic Label Rating
Metronidazole 200 mg Flagyl Metronidazole Off-Label
Augmentin Augmentin Amoxicillin/Clavulanate Off-Label
http://www.nmihi.com/a/azithromycin.html Zithromax Azithromycin Off-Label
Cleocin Clindamycin Off-Label

What might complicate it?

In some cases, pus from a dentoalveolar abscess can drain through the alveolar bone into soft tissue below, causing inflammation or even infection of the blood (bacteremia). When this type of infection occurs in individuals with a history of rheumatic fever or artificial heart valves, they are at risk for endocarditis (inflammation of the internal lining of the heart and particularly the heart valves).

Predicted outcome

A root canal and antibiotic therapy is usually effective in saving the tooth. If the tooth cannot be saved, it must be extracted. This is a last resort.

Alternatives

A fractured tooth can have similar acute symptoms.

Appropriate specialists

Dentist, endodontist, and periodontist.

Last updated 18 December 2011


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