Dental Abscess Literature Review on Diagnosis and Management of Dental Abscess

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© 2022 Archives of Pharmacy Practice
108
Review Article
Dental Abscess Literature Review on Diagnosis and
Management of Dental Abscess
Mohammad Mady1, Kareman Hussain ALMuhanna2*, Bassam Ali Hamdi3, Abdulaziz Ayeid ALJazi4, Meznah Ali AlSayoufi5, Samaher
Abdulsattar Qurban6, Wejdan Abdulhakim AlSaiari7, Ragad Talal AlNounou8, Faisal Mutiran AlAnazi9, Maher Matar AlAnazi10, Reem
Abdullah ALhamedi11
1Department of Oral & Maxillofacial Surgery, Riyadh, Saudi Arabia. 2Faculty of Dentistry, Hoor Medical Centre, Dammam, Saudi Arabia.
3Faculty of Dentistry, Jazan University, Jazan, Saudi Arabia. 4Faculty of Dentistry, ALThager Hospital, Jeddah, Saudi Arabia. 5Faculty of
Dentistry, Mustaqbal University, Qassim, Saudi Arabia. 6Faculty of Dentistry, Alfarabi College, Jeddah, Saudi Arabia. 7Faculty of Dentistry,
AlNoor Specialist Hospital, Makkah, Saudi Arabia. 8Faculty of Dentistry, Dental beauty clinic, Jeddah, Saudi Arabia. 9Faculty of Dentistry,
Aljazerah Primary Health Care, Riyadh, Saudi Arabia. 10Faculty of Dentistry, Sulaymi Hospital, Hail, Saudi Arabia. 11Faculty of Dentistry, King
Saud University, Riyadh, Saudi Arabia.
Abstract
Odontogenic infections can result from several conditions, such as pulp necrosis, periodontal disease, pericoronitis, trauma, or surgery. The
three types of odontogenic or dental abscesses are endodontal or periapical, periodontal, and pericoronal, depending on where the infection
first developed. Periodontal abscesses, which are particularly common in people with untreated periodontal disease and in periodontal patients
during maintenance, are the third most frequent dental emergency. There are two main types of etiologies that can be distinguished based on
how they relate to periodontal pockets. Studies involving people who had non-alcoholic fatty liver disease were looked for in the Medline,
Pubmed, Embase, NCBI, and Cochrane databases. Incidence, etiology, and management options were analyzed. An easily treatable and
frequently preventable condition is a dental abscess. Dental treatment will be necessary if an abscess extends beyond the tooth because
antibiotics by themselves are ineffective in treating it. The airway may become compromised, or the infection may spread to the brain if it
invades the neck or faces fascial planes. At tertiary hospitals, appropriate management protocols have been established, but morbidity and
mortality still exist.
Keywords: Periodontal abscess, Microbiology, Etiology, Prevalence, Therapy
INTRODUCTION
Odontogenic infections can result from several conditions,
such as pulp necrosis, periodontal disease, pericoronitis,
trauma, or surgery. The three types of odontogenic or dental
abscesses are endodontal or periapical, periodontal, and
pericoronal, depending on where the infection first developed
[1, 2]. However, because abscesses of pulp necrosis origin
have also been referred to as dental, periapical, or
dentoalveolar abscesses, this nomenclature is somewhat
ambiguous [3]. A lesion with an expressed periodontal
breakdown that develops over a short period of time has clear
clinical symptoms, and has a localized pus collection inside
the gingival wall of the periodontal pocket is referred to as a
"periodontitis abscess" [4].
Dental infections can be challenging to treat acutely;
however, they are relatively easy to diagnose and access [5].
Dental caries (tooth decay brought on by poor oral hygiene),
trauma, or unsuccessful root canal therapy are the usual
secondary causes of dental abscesses or periapical infections.
These infections carry a high danger of becoming highly
painful and rising to the cerebral sinuses or into the deep neck
area if left untreated. Patients with significant discomfort,
poor dental hygiene, inadequate dental follow-up, unrepaired
dental injuries, palpable localized pain, facial erythema,
trismus, dysphagia, fever, and lymphadenopathy should all be
suspected of having a dental abscess.
Changes in mental status and dyspnea are warning signs that
should immediately raise suspicion. When looking inside the
mouth, the suspected infected tooth or teeth may be
discolored, have visible enamel cracks, or be surrounded by
erythematous and swollen gingiva. In addition to providing
symptomatic relief, recognizing, treating, and educating
This is an open-access article distributed under the terms of the Creative Commons
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Address for correspondence: Kareman Hussain ALMuhanna,
Faculty of Dentistry, Hoor Medical Centre, Dammam, Saudi
Arabia.
Karem_hu@yahoo.com
How to cite this article: Mady M, ALMuhanna KH, Hamdi BA,
ALJazi AA, AlSayoufi MA, Qurban SA, et al. Dental Abscess
Literature Review on Diagnosis and Management of Dental Abscess.
Arch Pharm Pract. 2022;13(1):108-10.
https://doi.org/10.51847/5VqXBIyWQf

Mady et al.: Dental Abscess Literature Review on Diagnosis and Management of Dental Abscess
Archives of Pharmacy Practice ¦ Volume 13 ¦ Issue 1 ¦ January – March 2022
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patients about a dental abscess can help them avoid
potentially severe complications [6].
Epidemiology
The majority of Americans have dental caries and poor oral
health. Ninety-one percent of adults between the ages of 20
and 64 have dental caries, according to data on dental caries
and tooth loss from the National Center for Health Statistics'
National Health and Nutrition Examination Survey from
2011 to 2012. For Hispanic, non-Hispanic black Americans,
and non-Hispanic Asian adults, these rates were lower than
those for non-Hispanic white adults [7]. About 27% of adults
between the ages of 20 and 64 have untreated tooth decay.
Hispanics had a 36% untreated dental decay rate, whereas
non-Hispanic Black Americans had a rate of 42%. About
19% of persons over 65 had untreated dental caries [7]. Visits
to the hospital emergency room (ER) for dental-related issues
and abscesses are typical. According to one study, the
population of the United States experienced one tooth
infection admission every 2600 people [8]. Dental abscesses
have much higher rates of pediatric ER visits (47%), which is
concerning.
In addition to pointing to the high frequency of poor dental
health, a crucial risk factor for developing a tooth abscess,
this data suggests that racial and possibly socioeconomic
variables are also at work. The community's population,
racial makeup, and socioeconomic demographics could
induce changes in providers' behavior [8].
MATERIALS AND METHODS
PubMed database was used for articles selection, and the
following keys were used in the Mesh (("Dental abscess "
[Mesh]) AND ("signs and symptoms" [Mesh]) OR
("Management" [Mesh])).
In regards to the inclusion criteria, the articles were selected
based on the inclusion of one of the following topics: Dental
abscess Features and treatment of dental abscesses. All other
articles that did not use one of these subjects as their main
conclusion were subject to exclusion criteria.
Out of 1,202 articles indexed in the previous two decades,
about 90 publications were selected as the most clinically
pertinent, and their full texts were assessed. After careful
review, 31 of the 90 were decided to be included. Using the
reference lists from the acknowledged and linked studies,
additional studies and publications were located. To assist
practicing physicians in the most straightforward and
practical way possible when assessing dental abscesses,
expert consensus recommendations and commentary were
added where appropriate.
Risk Factors
Some elements that may raise the risk of dental abscess are
the ones listed below [9]:
• Poor oral hygiene
• Bruxism (grinding or clenching teeth)
• Consuming a sugar-heavy diet
• Regular snacking and eating in between meals
• Consuming aerated drinks and other sweet liquids
• Experiencing dry mouth; This is because saliva clears
microorganisms and food particles away.
• Additional tooth or dental damage
An abscess is typically caused by bacteria getting inside the
tooth or gums. The following are the causes of abscesses,
depending on the type [10]:
1. Periapical abscess - Bacteria enter the tooth via decay or
fracture and reach the pulp. The infection spreads from
the pulp and exits through the apex or tip of the tooth root.
2. Gingival abscess - Bacteria on the tooth surface (plaque)
and gums can enter the gums if an injury occurs.
3. Periodontal abscess - Gum abscess can spread to
surrounding tissue and bone.
4. Peicoronal abscess - Bacteria multiply in the space
between the erupting tooth and the surrounding gums due
to poor oral hygiene and food impaction, resulting in an
abscess.
Symptoms and Signs
A dental abscess should be suspected when patients report
severe pain, confess to poor dental hygiene and inadequate
dental follow-up, confess to dental trauma that was left
unrepaired, have localized pain that is reproducible with
palpation, facial erythema, trismus, dysphagia, fever, and
lymphadenopathy. Alterations in mental status and dyspnea
are indicators that need immediate attention. The suspected
infected tooth or teeth may be discolored, have obvious
enamel breaks, or be surrounded by gingival erythema and
swelling when the oral cavity is examined [11].
Diagnosis
A periodontal abscess is diagnosed based on the patient's
symptoms and the signs found during the oral examination. A
thorough medical and dental history and a radiographic
examination and CT scan can provide additional information.
An ovoid elevation of the gingiva along the lateral part of the
root is the current sign, according to an examination. On the
other hand, periodontal abscesses might not be as obvious.
Mild discomfort to severe discomfort, gingival tenderness,
swelling, tooth mobility, tooth elevation, and palpable tooth
sensitivity are all possible symptoms [12].
A typical appearance or some degree of bone loss, ranging
from enlarging the periodontal space to dramatic radiographic
bone loss, may be seen on the radiographic examination.
In some severe cases, systemic involvement has been
reported, including fever, malaise, leukocytosis, and regional
lymphadenopathy [12]. Previous periodontal treatments, root
canal therapy, and abscesses can all be revealed by the dental
history. A careful anamnesis is used to diagnose abscesses
caused by foreign objects (gingival abscesses, oral hygiene
abscesses) [13]. It was suggested that positron emission

Mady et al.: Dental Abscess Literature Review on Diagnosis and Management of Dental Abscess
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Archives of Pharmacy Practice ¦ Volume 13 ¦ Issue 1 ¦ January – March 2022
tomography and a flurine-18-fluoromisonidazole marker be
used to detect periodontal abscesses and other anaerobic
infections in the mouth [14].
Treatment
Draining the abscess, giving antibiotics, reducing pain, and
removing the infected tooth source are all parts of the
treatment. Most of the time, oral antibiotics and a prompt
dentist appointment are enough to treat dental problems. A
hospital stay or the administration of intravenous (IV)
antibiotics may not be necessary in cases of dental abscesses
unless the patient displays alarming signs like fever, dyspnea,
or an airway compromise from swelling. Most dental
abscesses can be treated with gram-negative, facultative, and
strict anaerobe-covering antibiotics [5]. Odontogenic
infections can be treated with penicillins and cephalosporins,
but the production of B-lactamases is leading to an increase
in antimicrobial resistance.
Given the rise in antibiotic resistance, it would be preferable
to combine penicillins with other antimicrobials like
metronidazole or an antibiotic with a broad spectrum, such as
ampicillin-sulbactam and ampicillin-clavulanate [5]. While
ineffective against aerobic gram-positive organisms,
metronidazole is effective against anaerobic organisms. To
extend antimicrobial protection to include aerobic gram-
positive organisms, metronidazole should be taken in
addition to penicillin. For patients with penicillin and
cephalosporin allergies, clindamycin is a great option.
Excellent protection against gram-positive organisms,
anaerobes, and B-lactam-resistant organisms is provided by
clindamycin, which also has good bone penetration. It has
been demonstrated that Clindamycin is equally effective as
Penicillin V at treating severe odontogenic infections.
For severe infections or in patients with compromised
immune systems, extended-spectrum penicillins like
piperacillin-tazobactam or anti-pseudomonal antibiotics like
fourth-generation or higher cephalosporins should be taken
into consideration. Only very serious infections should be
treated with carbapenems like meropenem. Meropenem is
effective against resistant bacteria as well as gram-positive
and gram-negative bacteria [5]. The treatment for a dental
abscess may involve a root canal or tooth extraction. An
incision and drainage may be required for a periapical dental
abscess. Although incision and drainage can be performed in
a clinic or emergency room, a dentist must still monitor them.
The dental procedure known as a root canal exposes the
infected tooth roots by removing the tooth crown. These
passages are first opened with surgical tools, then cleaned
with a solution. The tooth crown is then put back on, and the
tooth root is filled. Complications include cracked teeth,
surgical instruments breaking off inside the tooth root canal,
and inadequate bacterial removal. These complications may
necessitate a second root canal or tooth extraction [15].
CONCLUSION
An easily treatable and frequently preventable condition is a
dental abscess. Dental treatment will be necessary if an
abscess extends beyond the tooth because antibiotics by
themselves are ineffective in treating it. The airway may
become compromised, or the infection may spread to the
brain if it invades the neck or faces fascial planes. At tertiary
hospitals, appropriate management protocols have been
established, but morbidity and mortality still exist. Dental
abscesses can be prevented, but all healthcare professionals
must practice careful antibiotic stewardship and provide
better access to dental care [16].
ACKNOWLEDGMENTS: None
CONFLICT OF INTEREST: None
FINANCIAL SUPPORT: None
ETHICS STATEMENT: None
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