Dental Abscess Health Article

Treatment

The goal of treating a dental abscess is to eliminate the infection while preserving the teeth and to prevent any complications. Releasing the direct pressure of the infection build up is the first step in the treatment.

With a periapical abscess, the pus is drained through an incision in the gum tissue, or by enlarging the hole in the tooth. This alleviates the pain and the tissue swelling. During this process the patient is given a local anesthetic to minimize the pain. Often with a periapical abscess, the infection is severe and pain is so intense that the anesthetic is injected into the tooth or infected area for immediate relief. Extraction of the tooth is sometimes required, especially if an injury to the tooth has fractured through the bifurcation area and saving the tooth is not possible.

The principle treatment for a periodontal abscess is to establish drainage of the inflammation and to eliminate the infective agent. Anesthetics are required because of the pain involved and the discomfort caused by scaling and root planing. Careful insertion of a dull probe into the pus pocket along the tooth will usually produce the drainage needed and the symptoms normally dissipate. Scaling and root planing through the periodontal pocket to rid the area of the cause of the infection is necessary.

If necessary, surgical procedures may be undertaken. Surgery aims at pocket reduction if not elimination. An incision into the gum tissue and the laying open of a flap of tissue may be necessary in order to reach the infection more easily. Surgery must be gentle and efforts are made to avoid damage to the remaining periodontal attachment. As soon as the etiologic factors have been eliminated the swelling is reduced.

The healing process is usually uneventful and regeneration frequently occurs. The abscess will recur unless the cause of the infection is removed and the depth of the pocket is reduced. Extraction of the tooth is indicated after the acute symptoms have subsided, but in some cases, normal tissue contours cannot be developed and maintained.

In cases where the periodontal destruction approaches the periapical region of the tooth (the apex) the patient may develop pulpitis. Treatment may cause the patient to experience pain and discomfort following the root planing treatment and treatment for pulpitis will need to be completed, usually with root canal therapy.

Antibiotics are vital in ridding the system of any infection for both periapical and periodontal abscesses. If the infection is not eliminated the abscesses will recur with a stronger infection and more severe symptoms.

The types of antibiotics prescribed for acute abscesses include:

• Penicillin VK: an initial dose of 1000 mg followed by 500 mg four times daily for seven days.
• Amoxicillin (Augmentin): 250 mg three times daily for ten days.
• Erythromycin: 1000 mg first followed by 500 mg four times daily for seven days (for patients allergic to penicillin).

For chronic infections or infections with an inadequate response to penicillin, clindamycin is often prescribed (300 mg daily for seven days).

Warm salt-water rinses can soothe the gum tissue and help with the healing process. Over-the-counter medication can be taken for pain along with the antibiotics. Medications such as acetaminophen (Tylenol) reduce fever (if any) and pain. Anti-inflammatory medicines such as ibuprofen (Motrin and Advil) aid in reducing fever and also help reduce swelling and inflammation in the tissue.

Prognosis

While the loss of periodontal attachment is commonly rapid during an acute periodontal abscess, the potential for repair and healing is very high if the abscess is treated quickly and appropriately. The prognosis for a periapical abscess is similar, if it is treated quickly and appropriately with the elimination of the infection that is causing the abscess.