What is the treatment for a dental abscess?

Treatment of Dental Abscess

The cornerstone of treatment for a dental abscess is drainage of the abscess through endodontic treatment or extraction of the affected tooth, along with appropriate antibiotic therapy based on the severity and extent of the infection. 1, 2

Initial Management

Assessment of Severity

• Evaluate for signs of severe infection:
  • Facial swelling
  • Difficulty swallowing or breathing
  • Fever
  • Systemic inflammatory response syndrome (SIRS)
  • Spread beyond the confines of the jaw

Treatment Algorithm

For Localized Dental Abscesses:

1. Dental Intervention (Primary Treatment)

   • Permanent teeth: Endodontic treatment (root canal) is the preferred option 1
   • Deciduous teeth: Decision to extract or treat endodontically depends on:
     • Extent of infection
     • Recurrence
     • Expected timing of normal exfoliation 1

2. Antibiotic Therapy

   • First-line oral antibiotic: Amoxicillin-clavulanic acid 875/125 mg PO every 12 hours 3, 4
   • For penicillin-allergic patients:
     • Non-anaphylactic: Cephalexin 500 mg four times daily
     • Anaphylactic: Clindamycin 300-450 mg four times daily 3, 5

For Severe or Spreading Infections:

1. Immediate referral to emergency department or oral surgeon
2. Surgical drainage of the abscess 3, 2
3. Intravenous antibiotics:
   • Vancomycin plus piperacillin-tazobactam 3
4. Obtain cultures before starting antibiotics when possible 3
5. Continue IV antibiotics until clinical improvement, then transition to oral therapy for a total of 7-14 days 3

Special Considerations

Duration of Treatment

• Continue antibiotic treatment for 48-72 hours beyond resolution of symptoms 4
• For infections caused by Streptococcus pyogenes, continue treatment for at least 10 days 4, 5

Monitoring and Follow-up

• Re-evaluate in 48-72 hours to assess healing progress 3
• Monitor for complications:
  • Spread to adjacent structures
  • Systemic infection
  • Recurrence
  • Fistula formation 3

Potential Complications

Severe Complications

• Airway obstruction
• Septicemia
• Spread to other body sites (intracranial abscesses, perihepatic abscess)
• Osteomyelitis of the jaw 2, 6

Important Cautions

• Antibiotics alone will not resolve a dental abscess; definitive treatment requires drainage 2
• Failure to provide proper drainage can lead to progressive worsening of infection 2
• Clindamycin should be discontinued if significant diarrhea occurs due to risk of C. difficile infection 5

Microbiology

• Dental abscesses typically involve polymicrobial infections with predominance of anaerobic bacteria 7
• Common bacteria include species from genera Fusobacterium, Parvimonas, Prevotella, Porphyromonas, Dialister, Streptococcus, and Treponema 7

By following this treatment approach, dental abscesses can be effectively managed to prevent serious complications and promote healing.