Dental abscess - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Dental abscess covers a clinical spectrum from minor well-localized infection to severe life-threatening complications involving multiple fascial spaces.
The vast majority of otherwise healthy patients presenting with a dental infection can be managed on an outpatient basis.
Common presenting symptoms include dental pain/toothache; intraoral and/or extraoral edema, erythema, or discharge; and thermal hypersensitivity.
A major consideration is the potential for airway obstruction as a consequence of extension of the infection into fascial spaces surrounding the oropharynx.
Panoramic dental x-ray reveals the source of infection in most cases; however, a periapical x-ray may also be helpful. A computed tomography scan is recommended if there is suspicion of a fascial space infection or if panoramic or periapical x-rays are not available.

Sagittal CT scan with contrast showing submandibular space abscess

From the personal collection of Melanie S. Lang and Thomas B. Dodson

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Poor oral hygiene with lack of dental care and resultant rampant decay
Panoramic x-ray showing decayed bilateral mandibular third molars and failed root canal treatment with periapical lesion related to the right mandibular first molar (middle arrow); also shows carious bilateral mandibular third molars on both sides
Panoramic x-ray showing generalized advanced horizontal periodontal bone loss with periapical radiolucency (see arrow) related to left mandibular first molar
Panoramic x-ray with gutta percha tracking of intraoral fistula; shows large periapical radiolucency related to failed root canal treatment (note the multiple root canal-treated teeth)
Periapical x-ray showing large periapical radiolucency related to root canal-treated lateral incisor; final pathology was consistent with a periapical cyst
Panoramic x-ray showing periapical abscess related to the lower-left second molar
Sagittal CT scan with contrast showing submandibular space abscess
Extraoral sinus tract in the right anterior neck related to retained necrotic mandibular first molar

Citations

Key Articles

Farmahan S, Tuopar D, Ameerally PJ, et al. Microbiological examination and antibiotic sensitivity of infections in the head and neck. Has anything changed? Br J Oral Maxillofac Surg. 2014 Sep;52(7):632-5.[Abstract]
Flynn TR, Shanti RM, Hayes C. Severe odontogenic infections, part 2: prospective outcomes study. J Oral Maxillofac Surg. 2006 Jul;64(7):1104-13.[Abstract]
Flynn TR, Shanti RM, Levi MH, et al. Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg. 2006 Jul;64(7):1093-103.[Abstract]
Lieblich SE, Kleiman MA, Zak MJ. Dentoalveolar Surgery. In: Carlson ER, Sims PG, eds. American Association of Oral and Maxillofacial Surgeons Parameters of Care. J Oral Maxillofac Surg. 2012;5:e50-71.
Palmer N, ed. Antimicrobial prescribing in dentistry: good practice guidelines. 3rd ed. London, UK: Faculty of General Dental Practice (UK) and Faculty of Dental Surgery; 2020.[Full Text]
Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association. J Am Dent Assoc. 2019 Nov;150(11):906-21;e12.[Abstract][Full Text]
Flynn TR, et al. Oral and maxillofacial infections. Atlas of Oral Maxillofac Surg Clinics. 2000 Mar;8(1):77-100.[Abstract]
Jimenez Y, Bagan JV, Murillo J, et al. Odontogenic infections. Complications. Systemic manifestations. Med Oral Patol Oral Cir Bucal. 2004;(suppl 9):143-7;139-43.[Abstract][Full Text]
Ghaeminia H, Nienhuijs ME, Toedtling V, et al. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. Cochrane Database Syst Rev. 2020 May 4;5(5):CD003879.[Abstract][Full Text]

Other Online Resources

American Dental Association: mouth healthy - abscess (toothache)

Referenced Articles

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