Dental (periapical) abscess is an acute infection of the periapical tissue around the root of the tooth.
Patients may present with pain, oedema, and purulent discharge localised to the site of pathology with or without fever and tender cervical lymphadenopathy 1.
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 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.
Plain radiograph / OPG and CT
- well-defined lucency at or distal to the root apex, usually less than 1 cm 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
Treatment and prognosis
Some dental abscesses will spontaneously resolve but dental surgery and antibiotics are generally required 1,4.
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:
- meningitis and cerebral abscess
- Ludwig angina
- deep neck space infections
- odontogenic infections most commonly (~80%) affect the submandibular space 5
Possible differential considerations include
- 1. Primary Care: A Collaborative Practice, 4e. Mosby. ISBN:0323075010. Read it at Google Books - Find it at Amazon
- 2. Abrahams JJ. Dental CT imaging: a look at the jaw. Radiology. 2001;219 (2): 334-45. doi:10.1148/radiology.219.2.r01ma33334 - Pubmed citation
- 3. Oral Radiology: Principles and Interpretation, 7e. Mosby. ISBN:0323096336. Read it at Google Books - Find it at Amazon
- 4. Scheinfeld MH, Shifteh K, Avery LL et-al. Teeth: what radiologists should know. Radiographics. 2012;32 (7): 1927-44. Radiographics (full text) - doi:10.1148/rg.327125717 - Pubmed citation
- 5. Steinklein J, Nguyen V. Dental Anatomy and Pathology Encountered on Routine CT of the Head and Neck. AJR Am J Roentgenol. 2013;201 (6): W843-53. doi:10.2214/AJR.12.9616 - Pubmed citation
- 5. Chapman MN, Nadgir RN, Akman AS et-al. Periapical lucency around the tooth: radiologic evaluation and differential diagnosis. Radiographics. 2013;33 (1): E15-32. doi:10.1148/rg.331125172 - Pubmed citation
Lucent lesions of the jaw