From the Guidelines
Treatment of a buccal space abscess requires prompt surgical drainage combined with antibiotic therapy, as the buccal space is considered an area difficult to drain and is at high risk for complications. The primary intervention should be incision and drainage of the abscess, typically performed intraorally through the buccal mucosa, though external approaches may be necessary for extensive infections 1. Following drainage, empiric antibiotic therapy should be initiated, commonly with amoxicillin-clavulanate 875/125 mg orally twice daily for 7-10 days, as it provides coverage for both b-hemolytic streptococci and CA-MRSA 1. For penicillin-allergic patients, clindamycin 300-450 mg orally four times daily is an appropriate alternative, as it also provides coverage for both b-hemolytic streptococci and CA-MRSA 1. Severe infections may require hospitalization for intravenous antibiotics such as ampicillin-sulbactam 3 g every 6 hours or clindamycin 600-900 mg every 8 hours. Pain management with acetaminophen or NSAIDs is recommended, along with warm saline rinses (1/2 teaspoon salt in 8 oz warm water) 4-6 times daily to promote healing. Patients should maintain good oral hygiene and follow up within 48-72 hours to ensure resolution. Surgical drainage is essential because antibiotics alone cannot effectively penetrate and treat an abscess due to poor blood supply within the purulent collection. The buccal space communicates with other facial spaces, so prompt treatment is crucial to prevent spread of infection to adjacent spaces and potential life-threatening complications.
Some key points to consider in the treatment of buccal space abscess include:
- Incision and drainage is the primary treatment for cutaneous abscesses, including those in the buccal space 1
- Antibiotic therapy is recommended for abscesses in areas difficult to drain, such as the buccal space 1
- Empiric antibiotic therapy should provide coverage for both b-hemolytic streptococci and CA-MRSA 1
- Clindamycin and amoxicillin-clavulanate are appropriate options for empiric antibiotic therapy in the treatment of buccal space abscess 1
- Severe infections may require hospitalization for intravenous antibiotics and close monitoring 1
From the Research
Treatment Guideline for Abscess of Buccal Space of Mouth
The treatment for an abscess in the buccal space of the mouth typically involves a combination of surgical and pharmacological interventions.
- The primary goal is to drain the abscess and reduce the bacterial load, which can be achieved through incision and drainage or aspiration of the abscess 2.
- Antibiotics may be prescribed in conjunction with surgical drainage, especially in cases where the abscess is large or the patient has a compromised immune system 3, 4.
- The choice of antibiotic depends on the suspected causative organism and the patient's medical history, with clindamycin and trimethoprim-sulfamethoxazole being commonly used options 4.
- In some cases, antimycotic therapy may be necessary, especially if the abscess is caused by a fungal infection 5.
- Postoperative care is crucial to prevent complications and promote healing, and may include warm soaks, analgesia, and close follow-up 2.
Special Considerations
- The buccal space is a complex anatomical region, and abscesses in this area can be challenging to diagnose and treat 5.
- A thorough medical history and physical examination are essential to identify the underlying cause of the abscess and to rule out other potential diagnoses 5.
- Imaging studies, such as magnetic resonance or computed tomography, may be necessary to assess the extent of the abscess and to guide treatment 5.
- In some cases, referral to a specialist, such as an oral surgeon or an infectious disease specialist, may be necessary to ensure optimal management of the abscess 3, 5.