Definition
A.A dental abscess is a space infection of the gingival or periodontal tissues.
Incidence
A.Incidence is unknown.
Pathogenesis
A.An abscess occurs when bacteria gain access into the gingiva or periodontal tissues. Dental infections are often polymicrobial and usually caused by anaerobic gram-negative rods and gram-positive cocci.
Predisposing Factors
A.Poor dental hygiene.
B.Dental caries.
C.Low socioeconomic status.
D.Poor nutrition.
E.Physical and mental disabilities.
Common Complaints
A.Throbbing pain at infected site that may radiate to jaw, ears, cheek, neck, head.
B.Swelling (gingival edema).
C.Difficulty chewing with tooth due to pain.
Other Signs and Symptoms
A.Fever.
B.Warmth, redness.
C.Loss of appetite.
D.Heat and cold sensitivity.
E.Halitosis.
F.Trosmis (unable to open mouth).
Potential Complications
Risk of complications increases with valvular disease. The following are complications:
A.Sepsis.
B.Leukocytosis associated with facial cellulitis.
Subjective Data
A.Elicit information from the patient regarding onset, duration, location, and quality of pain.
B.Note radiation of pain as well as alleviating or aggravating factors.
C.Note if pain is brought on by contact with hot, cold, or sweet substances; this may indicate periapical abscess or dental caries.
D.Ask if the patient has a fever. If so, how high and for how long?
E.Inquire about history of mitral valve prolapse or rheumatic fever.
Physical Examination
A.Check temperature, pulse, respirations, and blood pressure.
B.Inspect:
1.Inspect teeth for caries, mobility of teeth or protrusion from sockets, and gum disease.
2.Examine teeth for erosion, enamel decalcification, diminished tooth size, discoloration, and sensitivity to temperature changes.
C.Palpate:
1.Palpate neck and submental area for enlarged, tender lymph nodes.
D.Percuss:
1.Percuss all teeth. Tenderness is diagnostic of an abscess.
E.Auscultate:
1.Auscultate heart and lungs.
Diagnostic Tests
A.None usually required.
B.White blood cell (WBC), if cellulitis is suspected.
C.X-rays may be considered.
D.CT with contrast, if cellulitis suspected.
Differential Diagnoses
A.Dental abscess.
B.Periodontal disease.
C.Cellulitis.
D.Peritonsillar abscess.
Plan
A.General interventions:
1.Treat immediate infection.
2.Refer to dentist for immediate evaluation and treatment.
B.Patient teaching:
1.Advise patient to apply a heating pad to painful facial area for comfort.
2.Advise soft diet until pain resolves.
3.Review daily dental care and hygiene with patient.
C.Pharmaceutical therapy:
1.Drug of choice: Amoxicillin 500 mg three times per day for 7 to 10 days OR amoxicillin/clavulanic acid (Augmentin) 500 mg or 875 mg twice a day. Dental consultation required.
2.Other medications:
a.Cephalexin (Keflex) 500 mg every 6 hours until dental consultation.
b.Clindamycin (Cleocin) 300 mg orally every 8 hours until dental consultation.
3.For discomfort and fever: Ibuprofen (Advil) 400 to 600 mg orally every 6 to 8 hours, not to exceed 1,200 mg/d. Tylenol 500 mg orally every 4 to 6 hours may be used for patients with renal impairment. Consider renal function when prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) to older adults and geriatric patients.
Follow-Up
A.Follow up 2 to 3 days after dental exam to evaluate results, as needed.
Consultation/Referral
A.Advise the patient to see a dentist promptly, even if pain resolves.
Individual Considerations
A.Pregnancy:
1.Patients may safely have dental procedures during pregnancy.
2.X-ray films may be taken with lead shield over patient’s abdomen.
3.Epinephrine and nitrous oxide should not be used during dental procedures.
4.Tetracycline should not be used; it causes staining of fetal bones and teeth.
B.Geriatrics.
1.Two primary oral factors with elderly propensity for dental abscess are the following:
a.Xerostomia—hypofunction of salivary glands, medications (antihypertensives, antidepressants, antipsychotics), and diabetes.
b.Facial pain—root caries, and reduced masticatory ability (could lead to malnutrition), which lowers the body’s immune system.
2.Observational studies indicate that the elder population with remaining teeth tend to have less dental abscesses or peridental problems. They performed appropriate physical functioning, were less frail, and maintained better oral healthcare. These factors decrease the risk of health problems and infections that arise during the aging process.
3.When oral healthcare educational programs are implemented to geriatrics (in the community setting or long-term care facility) plaque levels improved and a trend of gingival bleeding/infections decreased. Encourage elder patients and their families to maintain oral healthcare and visit a dentist regularly.