Although rare, dental
A localized collection of pus surrounded by inflamed tissue.
can spread in a retrograde fashion via the vasculature to the cavernous sinus. This can lead to the formation of a blood clot or cavernous sinus thrombosis. Patients may present with headache, fever, periorbital edema or pain, and cranial nerve abnormalities. This infection can be life-threatening and must be addressed emergently.
The flora of a dental abscess is usually a mix of bacteria, with anaerobic gram negative rods and gram positive cocci (eg, Bacteroides, Fusobacterium, Peptococcus, Peptostreptococcus, Streptococcus viridans) playing a significant pathogenic role. Therefore, first-line empiric antibiotic therapy for dental abscesses is penicillin or amoxicillin and clindamycin for penicillin-allergic patients. Suspicion of a dental abscess requires urgent referral to a dentist for definitive care.
The treatment of a dental abscess does not differ from the treatment of an abscess in any other part of the body. Efforts must be made to locate the site of infection, incise and drain the pus collection, and collect a specimen for culture and sensitivities. Unfortunately, an abscessed tooth often must be extracted, although in cases limited to pulpitis, a root canal may be performed to salvage the tooth. Antibiotic therapy is also required, especially in cases of contiguous spread of the infection. For more severe infections, intravenous delivery of the antibiotics is necessary and patients may require hospitalization.