aneoi7 Dental Abscess Clinical Presenlaion: History, Physical, Causes
Medscape
Dental Abscess Clinical Presentation
Updated: Aug 02, 2016
Author: Jane M Gould, MD, FAAP; Chief Editor: Russell W Steele, MD more...
PRESENTATION
History
The following may be reported in patients with dental abscess:
+ Localized pain and swelling (may progress over a few hours to days): Examples of swelling
are shown in the following images.
Obvious swelling of the right cheek due to dental abscess.
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Side view. Fluctuant mass extending toward the buccal side of the gum end to the gingival-buccal
reflection
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Thermal sensitivity (periapical abscess): This is thought to occur secondary to exposure of
the dentine to the external environment as a result of enamel loss or gingival recession.
Fever
Gingival bleeding (on occasion with periodontal abscess)
Decreased intake of fluid, food, or both
Physical
Gingiva
‘Swelling
Warmth
Erythema
Fluctuant mass that usually extends toward the buccal side of the gum and to the gingival-
buccal reflection
+ Parulis or "gum boil" (a soft, solitary, reddish papule located facial and apical to a chronically
abscessed tooth that occurs at the endpoint of a draining dental sinus tract) [9
Teeth: The tooth that is most frequently involved is the lower third molar, followed by other lower
posterior teeth; upper posterior teeth are involved much less frequently, and anterior teeth are
rarely involved,
* Increased mobility (mostly periapical abscess)
+ Pressure or percussion tenderness (mostly periapical abscess)
+ Extrusion
Regional lymph node involvement
More severe infection
Trismus, indicating involvement of the masticator space
Difficulty swallowing (dysphagia)
Respiratory difficulty
Necrotizing fasciitis !71
Neck or facial swelling (see Complications)
Signs of dehydration
Causes
Dental caries are caused by the following
* "Infant-bottle" tooth decay or "nursing" caries: The term "early childhood” caries is replacing
these terms because the description also includes dental caries in breastfed babies. The
American Academy of Pediatrics (AAP) along with the American Academy of Pediatric
Dentistry issued a clinical report entitled "Oral and Dental Aspects of Child Abuse and
Neglect,” which states that the caregivers of children who present for dental care with severe
early childhood caries must be carefully interviewed to differentiate caregivers with adequate
knowledge and willful failure to seek dental care from caregivers without knowledge or
awareness of a child's dental needs. Failure to seek dental care may result from many
socioeconomic factors, and clinicians should determine if dental care is readily available and
accessible when considering the possibility of negligence. Physicians and dentists are
required by law to report suspected cases of child negligence and abuse. 9]
+ Plaque: This is a noncalcified precipitate of microorganisms and their byproducts that
adheres to the enamel of teeth.
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In immunocompromised patients, bacteria may hematogenously spread to invade the pulp of the
tooth,
Gingivitis is an inflammation of the gingiva without attachment loss or with nonprogressing
attachment loss.
Posttraumatic infection or postsurgical infection may also cause dental abscess.
Differential Diagnoses
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