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Dental abscess

Dr Daniel J Bell and Dr Henry Knipe et al.

Dental (periapical) abscesses are an acute infection of the periapical tissue around the root of the tooth.

Patients may present with pain, edema, and purulent discharge localized to the site of pathology with or without fever and tender cervical lymphadenopathy 1.

Dental caries result in damage to the tooth enamel, which allows bacteria access to the dental pulp. From here the infection spreads down the root canal and out of the apical foramen where abscess formation occurs 2,4.

Early dental abscesses, within the first ten days, may not have any radiographic features 3,4.

  • well-defined lucency at or distal to the root apex, usually <10 mm with or without surrounding (<22 mm) sclerosis 2-4
  • the tooth or teeth involved often show signs of caries
  • an empty socket may indicate recent extraction for infection

Some dental abscesses will spontaneously resolve but dental surgery and antibiotics are generally required 1,4. Most (~90%) will show some evidence of healing (bone filling the lucency) one-year post-treatment 4.

Dental abscesses can exert pressure on the root of the tooth, which contains the neurovascular bundle, and can lead to devitalisation of the tooth 5

Complications range from contiguous or haematogenous spread of infection and include potentially fatal conditions 1-4:

Possible differential considerations include:

Article information

rID: 26220
System: Head & Neck
Synonyms or Alternate Spellings:
  • Periapical abscess
  • Periapical dental abscess
  • Dental abscesses
  • Periapical abscesses

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Cases and figures

  • Case 1
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  • Case 2: OPG
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  • Case 2: with masticator space abscess
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  • Case 3
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  • Case 4
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  • Case 5: with parapharnygeal abscess
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  • Case 6: with maxillary sinusitis
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  • Case 7: submandibular odontogenic abscess
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  • Case 8: OPG
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  • Case 9
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  • Case 10: OPG
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