Dental Abscess

Dental Abscess requires a Dentist for Definitive Treatment

Symptoms:

  • Dental Pain
  • Unpleasant taste
  • Fever and Malaise
  • Trismus
  • Dysphagia
  • Facial Swelling
  • Regional Lymphadenopathy
  • Tooth Decay
  • Gum Swelling or tenderness
  • Purulent Exudate

Differential Diagnosis

  • Other infections
    • Sinusitis
    • Mumps
    • Acute otitis Media
    • Facial Cellulitis
  • Salivary Gland obstruction

When to Admit?

  • Airway compromise
  • High fever
  • Significant Mandibular /submandibular or infraorbital swelling
  • Floor of Mouth Swelling – may indicate Ludwigs Angina (Lateral parapharyngeal abscess / deep neck infection)
  • Spreading infection
  • Neurological signs
  • Dehydration

Treatment

Definitive treatment needs a dentist – advise patient to call 111 for an emergency appointment if they are not registered

For Discharge: –

  • Analgesia – Paracetamol, Co-codamol 8/500 and Ibuprofen are bought from pharmacy. Prescribe TTO Codeine for those whose pain is not controlled despite this.
  • Antibiotics – only for the systemically unwell or those at high risk of complications (immunocompromised/diabetes etc)
    • Amoxicillin – 500mg TDS 7/7 plus Metronidazole 400mg TDS 7/7
    • Penicillin Allergy – Clarithromycin 500mg BD 7/7  plus Metronidazole 400mg TDS 7/7

Admission

  • Regular Analgesia -IV if necessary
  • IV Antibiotics
    • Benzypenicillin 2.4g IV 6 hourly and Metronidazole 500mg IV 8 hourly
    • Penicillin Allergy –  IV Clindamycin 600mg 6 hourly
  • OPT X-ray and request images sent to BRI
  • Refer Max Fac BRI for admission to ward 18

 

Complications of dental abscess include:

  • Loss of the affected tooth.
  • A fistula or sinus tract may develop that can discharge intraorally or into the overlying skin.
  • Spread of infection (more common in immunocompromised and elderly people), for example:
    • Maxillary sinusitis.
    • Cellulitis/periorbital cellulitis.
    • Osteomyelitis.
    • Retropharyngeal abscess.
    • Cavernous sinus thrombosis. 
    • Encephalitis and meningitis.
    • Brain abscess.
    • Mediastinitis.
    • Ludwig’s angina — a serious, potentially life-threatening infection of the tissues of the floor of the mouth. Symptoms include swelling, pain on raising of the tongue, swelling of the neck and the tissues of the submandibular and sublingual spaces. Malaise, fever, dysphagia (difficulty swallowing), trismus and, in severe cases, stridor or difficulty breathing can occur.
  • Sepsis — rarely, sepsis can develop from odontogenic infections.
  • Airway obstruction — caused by spread of infection into the fascial spaces around the oropharynx.

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