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Periapical abcess
From WikEM
Contents
Background
- Associated with dental caries or nonviable teeth
- Significant erosion of the pulp with bacterial overgrowth
Clinical Features
- Acute pain, swelling, and mild tooth elevation
- Exquisite sensitivity to percussion or chewing on the involved tooth
- Swelling in surrounding gingiva
- None in buccal or submandibular soft tissues
- May see small white pustule in gingival surface characteristic for abscesses
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Dental caries (pulpitis)
- Ludwig's angina
- Periapical abcess
- Periodontal abscess
- Peritonsillar Abscess (PTA)
- Retropharyngeal abscess
- Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)
- Vincent's angina - tonsillitis and pharyngitis
- Acute alveolar osteitis
Other
- Scurvy
- Gingival hyperplasia
- Phenytoin
- Cyclosporine
- Nifedipine, Amlodipine
- Leukemia
Evaluation
- Normally clinical
Management
- Appropriate analgesia
- Dental follow-up within 48 hrs.
Antibiotics
treatment is broad and focused on polymicrobial infections
- Penicillin VK 500mg PO q6 hours OR
- Clindamycin 300mg PO q8 hours
- Ampicillin/Sulbactam 3g IV q6 hours
I&D
- Can be performed in ED depending on provider comfort or by a dental consultant
See Also
References
- ER Atlas
Authors
Aaron Snyder, Ross Donaldson, Yos Yachivev, Neil Young, Marissa Camilon
