IBRAHIM ABU BAKR MAKIGA

ACUTE ALVEOLAR ABSCESS

ACUTE ALVEOLAR ABSCESS

• It is inflammatory reaction in pulpal infection and necrosis characterized by rapid onset ,spontaneous pain, tenderness of the tooth to pressure ,pus formation and eventual swelling of associated tissues.

CAUSES• Trauma

Chemical or mechanical • Bacterial invasion of dead pulp

tissue from carious lesion

• Failed RCT

BACTERIOLOGY

• Streptococci• staphylococci

•

WHAT IS THE COMMON CAUSE?WHAT IS THE COMMON CAUSE?

SYMPTOMS

• First symptom maybe Tenderness of the tooth that maybe relieved by continued slight pressure on the extruded tooth to push it back to the socket.

SYMPTOMS• Later patient has severe

throbbing pain with swelling of overlying tissue.

• The tooth become more painful ,elongated and mobile

SYMPTOMSAs the infection progresses the swelling enlarges

SYMPTOMS• If left untreated the infection may

progress to chronic apical abscess wherein the contain pus may break through to form a sinus tract usually opening in the labial or buccal mucosa.

SYMPTOMS• It may further progress onto

osteomyelitis or cellulitis.• General systemic manifestation

maybe seen

1.patient appear pale, weakened from pain and loss of sleep.

2.Pyrexia and patient may complain of headache

DIAGNOSIS• By clinical examination and

subjective symptoms given by the patient.

• RADIOGRAPHIC

shows defective restoration or cavity

Shows widening of the pdl space

DIAGNOSIS CONFIRMATION• Electric pulp test or by thermal

test • The tooth doesn’t respond to

electric pulp test or cold test• Tender to percussion ,apical

mucosa is tender to palpation and the tooth maybe mobile and extruded

DIAGNOSISHISTOPATHOLOGY

Marked infiltration of PMNs

Rapid accumulation of exudate

Empty spaces where suppuration has occurred

DIFFERENTIAL DIAGNOSIS• PERIODONTAL ABSCESS

vital tooth

periodontal pocket formation

pus may exude from the sulcus on pressure

respond to vitality test

Caries may not be present

TREATMENT

START BY DOING WHAT IS NECESSARY,THEN WHAT IS POSSIBLE AND SUDDENLY YOU ARE DOING THE IMPOSSIBLE

FRANCIS OF ASSISI

SURGICAL TREATMENT

• Immediate Rx is incision and drainage

• Trephination maybe required• If non restorable extraction is

indicated

ENDODONTIC TREATMENT

• Root canal treatment followed by crown

PHARMACOTHERAPY

• ANALGESIC AND ANTI-INFLAMMATORY

NSAIDs

Ibuprofen 200-800mg

Diclofenac (sodium/potassium) 50-100mg

DYNAPA-AQ 75mg IM

OPIOIDS

Tramadol 50mg

Codeine 60mg

PHARMACOTHERAPY

• ANTIBIOTIC

Caps Amox 500mg or any appropriate antibiotic

POST OPERATIVE INSTRUCTIONS • Avoid chewing sticky foods .• Avoid biting hard foods and hard substances.• If possible, chew only on the opposite side of your mouth.• Take medication as recommended by your dentist• Rinse three times a day with warm salt water• Maintain good oral hygiene