What is the treatment for a dental abscess?

Dental Abscess Treatment

The primary treatment for a dental abscess is surgical intervention through root canal therapy, extraction, or incision and drainage, with antibiotics reserved only for specific circumstances such as systemic involvement or medically compromised patients. 1

Types of Dental Abscesses

• Dental abscesses are localized collections of pus that can occur in different parts of the tooth and surrounding tissues, commonly resulting from untreated dental caries, trauma, or periodontal disease 2
• Acute dentoalveolar abscess presents with pain, swelling, and sometimes systemic symptoms like fever 1
• Periapical abscess forms at the root tip of a tooth due to pulpal necrosis 2
• If left untreated, infection can spread beyond the confines of the jaws, increasing risk of airway obstruction and septicemia 3

Primary Treatment Approach

• Surgical management is the first-line treatment through one of the following approaches:

  • Root canal therapy (for salvageable teeth) 1
  • Tooth extraction (for non-restorable teeth) 1
  • Incision and drainage of the abscess 1

• Treating with antibiotics alone is insufficient and will allow the infection to progressively worsen 3

• In cases of acute apical abscess, mechanical treatment (drainage) should be the first step, not antibiotics 4

When to Use Antibiotics

• Antibiotics should only be considered in specific situations:

  • Patients with systemic involvement (fever, lymphadenopathy, facial swelling) 1
  • Medically compromised patients 1
  • Infections extending into cervicofacial tissues 1
  • Failure to respond to surgical treatment alone 1

• Phenoxymethylpenicillin is the first choice for patients requiring antibiotics 1

• Amoxicillin for 5 days is an alternative for dentoalveolar abscesses requiring antibiotics 1

• Doxycycline can be considered as an alternative in adults 1

Diagnostic Approach

• For suspected periapical infections, intraoral radiographs are indicated to identify the source tooth 5
• If a fistula is present, diagnosis requires an intraoral radiograph with a gutta-percha cone inserted inside the fistula to trace the source 5
• Swelling of the periapical tissues justifies intraoral X-ray examination, preferably using a dedicated film holder and beam aiming device 5

Special Considerations

• For severe infections with systemic involvement, parenteral antibiotics may be necessary 1
• Immunocompromised patients or those with significant comorbidities may require a lower threshold for antibiotic therapy and broader coverage 1
• Consultations by ear-nose-throat specialists and maxillofacial surgeons should be carried out in cases with suspected or evident ear-nose-throat or dental infections 5
• Dexamethasone may be considered as an adjunct to conventional therapies for inflammation and pain management, showing significant reduction in pain at 12 hours post-treatment 6

Warning Signs for Urgent Referral

• Infections extending to underlying soft tissues require immediate treatment 1
• Prompt assessment and referral to a tertiary hospital is required for cases at risk of airway compromise 3
• Signs of spreading infection include:
  • Facial swelling
  • Difficulty swallowing or breathing
  • Fever and malaise
  • Trismus (limited mouth opening) 3

Common Pitfalls to Avoid

• Treating with antibiotics alone without addressing the source of infection through surgical intervention 3, 4
• Unnecessary prescription of antibiotics for conditions like acute irreversible pulpitis, chronic apical abscess, or gingivitis 4
• Delaying treatment, which can lead to spread of infection and potentially life-threatening complications 3
• Failing to provide drainage as local therapy in cases of acute apical abscess 4