From the Guidelines
For a possible dental abscess, ultrasound (US) is the recommended imaging scan due to its high sensitivity and specificity in diagnosing abscesses, as well as its ability to evaluate internal characteristics and associated pathology without the need for IV contrast. When considering the diagnosis of a dental abscess, it is crucial to prioritize imaging modalities that can accurately detect fluid collections, such as abscesses, and assess the extent of infection. According to the study by Gaspari et al, as cited in 1, US correctly diagnosed an abscess in 29 out of 30 patients, with an overall sensitivity and specificity of 96.7% and 85.7%, respectively. Some key benefits of using US for diagnosing dental abscesses include:
- High sensitivity and specificity in detecting abscesses
- Ability to evaluate internal characteristics of the abscess cavity, such as necrosis or debris
- Capability to assess associated pathology, like foreign bodies, fistulas, and vascular injury
- Non-invasive and does not require IV contrast However, it is essential to note that US may be limited in evaluating deeper soft tissue structures and adjacent bone involvement compared to MRI and CT, as mentioned in 1. In clinical practice, the choice of imaging modality may depend on the specific presentation and location of the suspected dental abscess, as well as the availability of imaging equipment and expertise.
From the Research
Imaging Scans for Dental Abscess
To diagnose a possible dental abscess, various imaging scans can be utilized. The choice of scan depends on the severity and location of the abscess.
- Computed Tomography (CT) scans are commonly used to define the localization and extent of inflammatory lesions, visualize soft tissue involvement, and identify the presence of an abscess or osteolytic lesion around the causative tooth 2.
- CT scans can also help identify the causative teeth, especially when trismus makes detailed clinical examination impossible 2.
- Ultrasound can be used as an intraoperative aid in the assessment of the abscess cavity and its real-time imaging facility can help in the location and drainage of the abscess cavity effectively 3.
- CT-guided navigation can be used as a successful surgical tool to aid in the surgery of patients with deep neck infections when it is difficult to accurately target the abscess due to inflammation 4.
Specific Findings
- A study found that CT scans revealed abscesses in 41.8% of cases, cellulitis in 36.4%, and mixed abscess and cellulitis in 21.8% of patients with maxillofacial abscesses of odontogenic origin 5.
- Another study reported that the initial CT scan detected 14 abscesses, 3 cases of non-suppurative lymphadenitis, and one case of retropharyngeal edema in children with retropharyngeal infection 6.
Recommendations
- CT scans are recommended for diagnosing and managing dental abscesses, especially in cases where the abscess is deep or difficult to access 2, 4, 5.
- Ultrasound-guided drainage can be considered as an alternative to surgical drainage in some cases 3.
- CT-guided percutaneous aspiration can be used as a diagnostic and therapeutic tool for retropharyngeal abscesses in children 6.