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Welcome
   bullet  Introduction
   bullet  Instructions
   bullet  Educational Objectives

Oral Pain
   bullet  Chapter Objectives
   bullet  Frequency & Nature of Oral Pain
   bullet  Diagnosing Oral Pain
   bullet  Analgesia Options

Oral Infections
   bullet  Chapter Objectives
   bullet  Reversible Pulpitis
   bullet  Irreversible Pulpitis
   bullet  Periapical Abscess
   bullet  Facial Cellulitis
   bullet  Pericoronitis
   bullet  Periodontal Abscess
   bullet  Antibiotic Options

Dental Trauma
   bullet  Chapter Objectives
   bullet  Epidemiology of Dental Trauma
   bullet  Patient History Requirements
   bullet  Triage & Extraoral Exam
   bullet  Intraoral Exam
   bullet  Alveolar Bone Fracture
   bullet  Chin Trauma & Condylar Fracture
   bullet  Dental Referrals

Trauma to Primary Teeth
   bullet  Chapter Objectives
   bullet  Primary Teeth & Injury Types
   bullet  Intrusion
   bullet  Luxation
   bullet  Avulsion
   bullet  Fractures

Trauma to Permanent Teeth
   bullet  Chapter Objective
   bullet  Intrusion
   bullet  Avulsion
   bullet  Avulsion Continued
   bullet  Crown Fractures
   bullet  Root Fractures
   bullet  Oral Piercing Complications

Injury Prevention
   bullet  Chapter Objective
   bullet  Your Role in Injury Prevention
   bullet  Mouth Guards Prevent Injuries

Summary & Assessment
   bullet  What Would You Do?
bullet  Take Home Message

Periapical Abscess


A periapical abscess is a localized, purulent form of periapical periodontitis.

The abscess can track through the bone to the soft tissue creating a localized fluctuant swelling, normally adjacent to the affected tooth root. This swelling may fistulize and drain or the infection can spread to surrounding tissues resulting in cellulitis.

Symptoms
Pain is well localized.
Tooth is typically percussion sensitive.
Pain may be severe, spontaneous, and persistent.
If the abscess is draining, pain may be less severe.

Treatment & Referral
Arrange urgent dental referral for root canal or extraction.
If tooth is not definitively treated, abscess is likely to recur.
Incision and drainage can provide temporary relief if not naturally draining.
Analgesics are necessary.
Antibiotics used only if concurrent cellulitis is present.

AAFP Home Study Program—with permission

Clinical Examples


Donald Greiner, DDS, MS


Joanna Douglass, BDS, DDS

Reference
Sutherland S, Matthews DC. Emergency management of acute apical periodontitis in the permanent dentition: a systematic review of the literature. Journal [Computer File]/Canadian Dental Association. 2003;69(3):160.

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