Acute Periapical Abscess

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

  1. Painful swelling at the root of tooth
  2. Sinus (may be present)
  3. Tooth is tender to biting or percussion
  4. 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

  1. Drain abscess using local anaesthesia by root canal extirpation if tooth is to be retained
  2. Otherwise extract the involved tooth
  3. 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, 0.6-2.7 g daily (in 2-4 divided doses) 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