A 40 year old man came with a history of trauma on 11 and repeating history of swelling of the same tooth.

On clinical examination there was presence of abscess on 12.radiographic finding verified loss of periodontal ligament space with the patient complaining of salty taste and the tooth 'feeling shaky' while eating. What is the diagnosis and treatment plan together with the physiologic and pathologic causes for this case. Acute Periapical Abscess collection of pus at the apex of a tooth with dead pulp Usually it is secondary to invasion of the pulp by bacteria after a cavity is formed in the tooth by dental caries although it can also occur following trauma to the tooth.

Clinical Features severe dental pain poorly localised by the patient and may keep them awake at night affected tooth frequently has a carious cavity, is discoloured, tender to percussion and may respond negatively to sensitivity tests, such as cold test As the abscess progresses, the infection spreads through the alveolar bone surrounding the tooth and into the soft tissues. This is associated with a decrease in the pain felt by the patient and a soft, fluctuant swelling which may be detectable clinically in the oral cavity. Diagnosis and Investigation history and examination but periapical radiographs and OPG Radiographic signs vary greatly in dental abscesses from a marked, well defined periapical radiolucency to a subtle widening of the periapical lamina dura. Microscopy, culture and sensitivity of aspirated or incised dental abscesses Management The root canal The tooth socket - following extraction of the tooth. Incision and drainage of any fluctuant intra-oral swelling Antibiotics

Antibiotics Dentoalveolar abscesses are usually polymicrobial and anaerobic in nature. Common organisms isolated are anaerobic streptococci, Actinomyces, Prevotella and Porphyromonas spp Despite resistance, amoxicillin or penicillin V remain first line with metronidazole or erythromycin the treatment of choice in those with penicillin allergies.

Spread Buccal - in the cheek lateral to the buccinator muscle Submandibular - below the angle of the mandible Sublingual - underneath the tongue Submental - below the chin Parapharyngeal - lateral to the pharynx in the posterior oral cavity Palatal

Complications Ludwig's Angina: Cavernous Sinus Thrombosis: Rarely, spreading facial cellulitis can infiltrate the cavernous sinus via the facial vein. This can cause life-threatening intracranial infection. Periapical abscesses When a periapical abscess develops, plaque bacteria infect your tooth as a result of dental caries (tiny holes caused by tooth decay) that form in the hard outer layer of your tooth (the enamel). Dental caries break down the enamel and the softer layer of tissue underneath (dentine) and eventually reach the centre of your tooth (pulp). This is known as pulpitis. The dental pulp in the middle of the tooth dies and the pulp chamber becomes infected. The bacteria continue to infect the pulp until it reaches the bone that surrounds and supports your tooth (alveolar bone), where the periapical abscess forms.