What is Acute Periapical Abscess?
Acute periapical abscess is a localized collection of pus in the periapical region of a tooth contained within the alveolar bone.
Causes of acute periapical abscess
- Acute periapical abscess may develop either directly from acute periapical periodontitis or more usually from a chronic periapical granuloma.
- It is generally the result of a mixed bacterial infection. Culture of the pus yields a wide range of different organisms:
- Strict anaerobes (e.g. prevotella, porphyromonas) usually predominante, but facultative anaerobes may be found
Symptoms and clinical features of acute periapical abscess
- Painful swelling at the root of tooth
- Sinus (may be present)
- Tooth is tender to biting or percussion
- Tooth mobility
Differential diagnoses
- Inflammatory radicular cyst
- Osteomyelitis
- Periodontal abscess
Investigations
- Radiographs (periapical)
Treatment for acute periapical abscess
Treatment objectives
- Relieve symptoms
- Eliminate the infection
Non-drug treatment
- Drain abscess using local anaesthesia by root canal extirpation if tooth is to be retained
- Otherwise extract the involved tooth
- Treat residual infection
Drug treatment
Amoxicillin
Adult: 250 mg orally every 8 hours for 5 to 7 days
Child: up to 10 years 125 mg every 8
hours, doubled in severe infections
Metronidazole
Adult: 200 mg orally every 8 hours for 3-7 days
Child:
- 1-3 years: 50 mg orally 8 hourly for 3-7 days;
- 3-7 years: 100 mg 8 hourly;
- 7-10 years: 100mg 8 hourly for 3-7 days
In Dentoalveolar abscess that has not
responded to penicillins or metronidazole
Clindamycin
Adult: 150-300 mg every 6 hours; up to 450 mg every 6 hours in severe infections
Child:
- 1 month – 18 years: 3-6 mg/kg(max. 450 mg) every 6 hours
- Neonate: Under 14 days 3-6 mg/kg 3 times daily
- 14 -28 days: 3-6 mg/kg (max. 450mg) 4 times daily
By deep intramuscular injection or by intravenous infusion, 0.6 to 2.7 g daily (in 2-4 divided doses) in life threatening infection, up to 4.8 g daily; single doses above 600 mg by intravenous infusion only; single doses by intravenous infusion not to exceed 1.2 g;
Caution
Discontinue immediately if diarrhoea or
colitis develops; monitor liver and renal
function if treatment exceeds 10 days, and in neonates and infants; avoid rapid
intravenous administration; avoid in acute porphyria.