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. The abscess will then fistulize and drain or spread to surrounding tissues causing cellulitis.


  • 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.

AAFP Home Study Program—with permission
AAFP Home Study Program—with permission

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 required only if concurrent cellulitis is present.

Clinical Examples

Donald Greiner, DDS, MS
Donald Greiner, DDS, MS
Joanna Douglass, BDS, DDS
Joanna Douglass, BDS, DDS


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

Karamifar K, Tondari A, Saghiri MA. Endodontic Periapical Lesion: An overview on the etiology, diagnosis, and current treatment modalities. European Endodontic Journal. 2020;5(2):54.