Usually a swelling found in relation to or around a carious tooth caused by the spread of infection following the death of the pulp.

Clinical Features

Tenderness of the tooth when tapped. Painful swelling which is either localised or sometimes spreads to other adjacent tissues. Usually it is found on the apical region of the tooth and could be with or without sinus. There is tenderness, headache and patient may be febrile. The abscess could be pointing or discharging.

Investigations

• X-ray (intra-oral).

Management

• Give oral antibiotics when abscess is localised e.g. amoxycillin 500 mg TDS for five days

• Analgesics and/or anti-inflammatory e.g. (indomethacin 25 mg TDS for 3 days - is preferred)

• Oral hygiene measures e.g. warm saline washes, povidone iodine washes

Admit If

• Patient is febrile, dehydrated and weak patient

• Severe trismus present

• Severe swelling is present:

- give injectable antibiotics, preferably crystalline penicillin QDS for 5 days combined with metronidazole and analgesics. In cases of penicillin allergy, give other available alternative antibiotics e.g. erythromycin

• Abscess is pointing or discharging - drain under LA (2% Lignocaine with adrenaline).

Find extent and cause of abscess if possible.

REFER TO DENTAL SURGEON.