Dentoalveolar Abscess or Periapical Abscess - Disorders of the Teeth

DENTOALVEOLAR ABSCESS OR PERIAPICAL ABSCESS

Periapical abscess, more commonly referred to as an abscessedtooth, involves the collection of pus in the apical dental periosteum (fibrous membrane supporting the tooth structure) and the tissue surrounding the apex of the tooth (where it is sus-pended in the jaw bone). The abscess has two forms: acute and chronic. Acute periapical abscess is usually secondary to a suppu-rative pulpitis (a pus-producing inflammation of the dental pulp) that arises from an infection extending from dental caries. The infection of the dental pulp extends through the apical foramen of the tooth to form an abscess around the apex.

Chronic dentoalveolar abscess is a slowly progressive infectious process. It differs from the acute form in that the process may progress to a fully formed abscess without the patient’s knowing it. The infection eventually leads to a “blind dental abscess,” which is really a periapical granuloma. It may enlarge to as much as 1 cm in diameter. It is often discovered on x-ray films and is treated by extraction or root canal therapy, often with apicectomy (excision of the apex of the tooth root).

Clinical Manifestations

The abscess produces a dull, gnawing, continuous pain, often with a surrounding cellulitis and edema of the adjacent facial structures, and mobility of the involved tooth. The gum opposite the apex of the tooth is usually swollen on the cheek side. Swelling and cellulitis of the facial structures may make it difficult for the patient to open the mouth. In well-developed abscesses, there may be a systemic reaction, fever, and malaise.

Management

In the early stages of an infection, a dentist or dental surgeon may perform a needle aspiration or drill an opening into the pulp chamber to relieve tension and pain and to provide drainage. Usually, the infection will have progressed to a periapical abscess. Drainage is provided by an incision through the gingiva down to the jawbone. Pus (purulent material) escapes under pressure. This procedure is commonly performed in the dentist’s office, but it may be performed in an outpatient surgery center or a same-day surgery department. After the inflammatory reaction has subsided, the tooth may be extracted or root canal therapy performed. Antibiotics may be prescribed.

Nursing Management

The nurse assesses the patient for bleeding after treatment and in-structs the patient to use a warm saline or warm water mouth rinse to keep the area clean. The patient is also instructed to take an-tibiotics and analgesics as prescribed, to advance from a liquid diet to a soft diet as tolerated, and to keep follow-up appointments.