Management of Jaw Pain with History of Dental Abscess
For jaw pain in patients with history of dental abscess, incision and drainage (I&D) is the cornerstone of treatment, with adjunctive antibiotic therapy (amoxicillin-clavulanate 875/125 mg PO twice daily for 7-14 days) recommended due to the facial location and risk of complications. 1
Immediate Management
Assessment and Diagnosis
- Evaluate for signs of active infection: painful, tender, fluctuant swelling with surrounding erythema
- Assess for systemic symptoms: fever, malaise, lymphadenopathy
- Determine extent of infection: localized vs. spreading to adjacent tissues
- Check for trismus (limited mouth opening), which may indicate deeper infection
Treatment Algorithm
Primary Treatment: Incision and Drainage
- I&D is essential for abscess resolution 1
- Deroofing technique preferred over simple I&D when possible (lower recurrence rates)
- Thoroughly evacuate pus and break up loculations
- Cover surgical site with dry dressing
Antibiotic Therapy
- First-line: Amoxicillin-clavulanate 875/125 mg PO twice daily for 7-14 days 1
- Alternatives (for penicillin allergy or suspected MRSA):
- Trimethoprim-sulfamethoxazole 160-320/800-1600 mg PO q12h (avoid in pregnancy)
- Doxycycline 100 mg PO q12h (avoid in children <8 years and pregnancy)
Supportive Care
- Warm compresses to promote drainage
- Pain management: acetaminophen or NSAIDs (avoid aspirin in children)
- Ensure adequate hydration
- Regular oral hygiene with gentle cleaning around affected area
Referral Guidelines
Immediate Referral (Emergency)
- Signs of airway compromise: difficulty breathing, stridor
- Rapidly spreading infection or significant facial swelling
- Systemic toxicity: high fever, altered mental status
- Risk of deep space infection: severe trismus, floor of mouth elevation
- Immunocompromised patients
Urgent Referral (24-48 hours)
- For dental evaluation and definitive treatment of the underlying cause
- Persistent symptoms despite initial management
- Recurrent abscesses in same location
Follow-up Care
- Re-evaluation within 48-72 hours to assess treatment response 1
- Daily assessment during treatment to monitor for complications
- Complete dental evaluation to address underlying cause and prevent recurrence
Important Considerations
Caution Points
- Dental abscess can be life-threatening if untreated, with risk of airway obstruction and septicemia 2
- Antibiotics alone will not resolve the infection; drainage is essential 2
- First molars are the most common source of odontogenic infections (29.5% of cases) 3
- Mandibular teeth cause more than twice as many exudative infections as maxillary teeth 3
Prevention of Recurrence
- Address underlying dental issues: caries, periodontal disease
- Regular dental check-ups
- Good oral hygiene practices
- Consider complete excision of any associated cyst once acute inflammation resolves 1
Potential Complications
- Spread to adjacent structures (maxillofacial cellulitis)
- Systemic infection/sepsis
- Osteomyelitis of the jaw 4
- Rare but serious: intracranial extension, distant abscesses 4
Remember that prompt treatment is crucial, as dental abscesses can lead to significant morbidity and even mortality if not properly managed 2. The combination of surgical drainage and appropriate antibiotic therapy offers the best outcomes for these patients.