What is the risk of developing a periapical (periradicular) abscess in the last upper molar?

From the Guidelines

The most effective treatment for a last upper molar abscess is surgical drainage, possibly accompanied by tooth extraction if the tooth is severely damaged, and adjunctive antibiotics such as amoxicillin for 5 days in specific patient groups, as recommended by the European Society of Endodontology 1. When considering the treatment of an abscess in the last upper molar, it's crucial to prioritize professional dental care due to the potential risks associated with the proximity of the tooth to vital structures. The primary approach should involve:

• Surgical drainage of the abscess
• Possible tooth extraction if the tooth is severely damaged
• Adjunctive antibiotics, such as amoxicillin, for specific patient groups, including medically compromised patients, patients with systemic involvement, and those with progressive infections The use of antibiotics should be reserved for cases where there is systemic involvement or in medically compromised patients, as stated by the European Society of Endodontology 1 and supported by other guidelines such as those from the Canadian Collaboration on Clinical Practice Guidelines in Dentistry 1. While waiting for professional treatment, patients can manage their symptoms with:
• Over-the-counter pain relievers like ibuprofen
• Rinsing with warm salt water several times daily However, it's essential to avoid delaying treatment or attempting to drain the abscess oneself, as this can lead to severe complications, including the spread of infection to nearby sinuses, the eye socket, or even the brain. The anatomy of the upper jaw facilitates the spread of infections through fascial planes to these critical areas, making prompt and proper treatment crucial.

From the Research

Last Upper Molar Abscess Risk

The risk of an abscess in the last upper molar can be managed through various interventions.

• The management of localized acute apical abscess in the permanent dentition should involve drainage of the abscess through a pulpectomy or incision and drainage 2.
• Antibiotics may be prescribed in addition to drainage of the tooth in cases of systemic complications or for immunocompromised patients 2, 3.
• The use of antibiotics in the management of pulpal- and periapical-related dental pain and intraoral swelling is generally not recommended, except in cases of systemic involvement or high risk of progression to systemic involvement 3.
• Dental abscesses can be diagnosed with clinical examination alone, but ultrasound may be a useful adjunct 4.
• The management of infected, abscessed primary teeth can be achieved through non-vital primary pulp therapy, which is a reliable and effective technique 5.
• The use of antibiotics for uncomplicated skin abscesses, including those in the dental region, may confer a modest benefit, but this is offset by a similar risk of adverse effects 6.

Factors Influencing Abscess Risk

• Systemic involvement, such as fever or lymphadenopathy, increases the risk of abscess formation and may require antibiotic therapy 2, 3.
• Immunocompromised status may increase the risk of abscess formation and require antibiotic therapy 2, 3.
• The presence of systemic complications, such as cellulitis, may increase the risk of abscess formation and require antibiotic therapy 2.

Management Strategies

• Incision and drainage is a recommended treatment for localized acute apical abscess in the permanent dentition 2, 4.
• Pulpectomy is a recommended treatment for localized acute apical abscess in the permanent dentition 2.
• Non-vital primary pulp therapy is a recommended treatment for infected, abscessed primary teeth 5.
• Antibiotic therapy may be recommended in cases of systemic involvement or high risk of progression to systemic involvement 2, 3.